REPORT OF THE REGIONAL COMMITTEE ANNEX 4
41
TECHNICAL DISCUSSIONS 1 SUBJECT
The subject of t~e technical discussions as decided by the Committee at its twelfth session was liThe Role of the Health Services in the Improvement of Conmmnity Water Supplies 11. 2 ORGANIZATION OF THE DISCUSSIONS
The first session consisted of an
introductory~tatement
by the Chairman, In the second
a panel presentation of the subject and an open discussion.
session, after introductory remarks by the Chairman, the participants were divided into sub-groups which met separately and conducted a free discussion in accordance with guidelines and references provided. The third session
was a.cain a plenary session in which the reports prepared by the sub-groups were presented and commented on.
3
FIRS~
SESSION w::~ch
In his introductory statement,
opened the first session, the
Cha.1rman summarized the references provided and briefly stated his views on the assigned subjects. Tbp. 1;nportance of adequate, convenient and pure The
water supply to the heelth of tb.'3 public was universally recognized.
interest of the health serriccs in good water supply was also universally accepted, and so was J",he necessity for a co-operative approach to this problem. Satisfactory pre gress in this field required team 'WOrk among
representatives of mpny disciplines, including particularly the medical or public health officer and the engineer. Agencies concerned 'With public
water supply and heel.th should be mutually supportive and should maintain
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REGIONAL COMMITrEE: THIRTEENTH SESSION
the closest liaison.
However, the proper relationship of the health agency
and the water supply authority, where this was different from the health agency, was not generally agreed and neither was the relative role of the medical and engineering professions within these agencies. In the panel discussion these areas of agreement and disagreement were confirmed. Each panel member spoke of the need for co-operation between
engineers and. medical officers and other professions in the prOvision and . maintenance of adequate and. wholesome public water supplies. Examples were
cited by panel members from conditions existing in countries in the Region.
In one country the public works department had entire responsibility for the public water supply. It assessed the need, designed, presented requests
for appropriations, constructed and supervised the operation of public water supplies. The public health department was kept informed of the results of
bacteriological and chemical examinations of the water shOwing its quality and was given the opportunity to comment, an ~ortunity of which it seldom
availed itself.
In the view of this water authority, there was no real
necessity for a larger role in community water supply for the health department. In t..nother country of the Region in which responsibility for design,
construction and operation of water supplies was given to a national water authority, there was a somewhat closer liaison with the health department, which maintained water analysis laboratories and collected and examined its own samples of community and private water supplies.
Any deterioration in
quality which might appear from these analyses then became the subject of discussion between the national water agency and the health department. health department, however, had no authority to order any changes made. The
REPOR!' OF THE REGIONAL COMMITTEE
In still another country, as explained by a panel member, the public works department again acted as a central water agency and was responsible for design, construction and operation of water works in urban areas. Water analyses were performed by a separate institute which reported For these urban areas,
both to the water agency and the health department.
the water agency and the health department consulted in regard to priorities ~-
in construction and the support of the health department was actively sought for appropriations for water works. The health department played an active,
even the primary, role in the water supply of rural and other areas having too small a concentration of population or inadequate economic resources presently to support a piped water supply. In these areas the health
department attempted to obtain improvement of individual water supplies and to raise water standards generally through the activities of its sanitary agents. In. yet another country cited, the public water supplies were generally
the primary responsibilities of local government bodies who obtained advice and support in design and construction from the national public works authority.
In this country the health department had recently taken the The grades were given
initiative in grading all the public water supplies.
by a team, which usually included both medical and engineering officers, and were in many instances considerably lower than had been expected by the local government bodies Owning and operating various water supplies. This grading,
and the publication of its results, was expected to result in are-assessment of the water supplies by their owners and a marked improvement in the quality of water supplied. In this country the health department was now en.g;>loying
public health engineers, the better to operate such surveillance activities in water supply and in other fields of environmental health.
REGIONAL COMMITTEE: THIRTEENTH SESSION
After the conclusion of the panel presentation, remarks from the floor confirmed that there were large discrepancies among the various countries of the Region in methods of controlling and operating public water supplies and that there was considerable variation in the role of the health department in this field. In one country of the Region the public health department had
set and enforced standards, not only for the quality of water, but also for treatment facilities. In this country no water supply could be constructed
or operated without a permit from the minister of health if the water supply served more than 20 000 persons. Ev~n
for those water supplies serving less
than 20 000 persons, for which permits were granted by the prefectural government and not by the ministry of health directly, the ministry of health standards prevailed. In considering whether to grant pennits, a thorough
review of the engineering plans was made by engineers of the health department staff. Health department engineers inspected the proposed water catchment In
areas and a thorough investigation was made before a permit was granted. this country, after the plans had. been approved by the health departzoont, construction of the larger 'WOrks was usually performed by the central government ministry of construction.
In summarizing the discussion at the first session, the Chairman remarked that all were agreed that good water was the responsibility of the government, that the provision of this water was a very complex problem, that an extensive system of checks on water quality was required and that these checks should be both internal and external in regard to the agency operating the water supply. It was not agreed as to whether the health department should provide
the external checks required, or, if it did, it was not agreed as to what force the health department's observations and opinions should have.
REPORT OF THE REGIONAL COMMITTEE
45
4
SECOND SESSION After receiving the instructions of the Chairman, participants divided
themselves among four sub-groups which met independently.
Each group
selected a chairman and a rapporteur and prepared a report on the subject, liThe Role of the Health Services in the Improvement of Community Water Supplies ". In each report, and among the various reports, the differences
of opinion previously noted again appeared.
5 THIRD SESSION In the third session the reports of the four discussion groups were presented and discussed. Based on the reports, and the discussion at this
session, the following conclusions were reached: (1) The health department has a moral responsibility in regard to the health aspects of public water supplies. This moral
responsibility is derived from the department's general responsibility for public health. (2) The preparation of standards for drinking water should be a legal responsibility of the health department. This
responsibility should be exerted in co-operation with the water authorities.
(3)
All certifications as to the safety of water should be made by the health department.
(4)
The review of the sanitary aspects of plans for proposed
water supplies is a proper health department function. Whenever this sanitary review involved engineering 'WOrk of any complexity, it should be performed by competent engineers on the staff of the health department.
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REGIONAL COMMITI'EE: THIRTEENTH SESSION
It is also proper for the health department to follow the progress of preliminary engineering investigation and design work for proposed water supplies. In some countries, the
requirement of approval of engineering plans by the health department, before construction can begin, has been satisfactorily applied. These countries have competent
specialized engineering sections within their health services. (5)
The health department should have at least an advisory role in goveri~nt
decisions un subsidies and loans for water
st:pply.
In one country of the Region, the health department
exercises direct control of such subsidies and loans with good results. (6)
The preparation of both short- and long-range plans for community water supplies at both is very i!l1j?ortant. n~~ional
and local levels
The health department should be represented
at a high level on bodies preparing such plans. (7)
The regular surveillance of the sanitary quality of water supplies, including the inspection of those operations of water works which might affect the sanitary quality of water, is considered to be very important. This surveillance and
inspection should be provided both by the agency operating the water supplies and by another agency external to the operating agency. The health department was the logical
external auditing agency and in some countries satisfactorily performed this function. The independent collection and
REPORT OF THE REGIONAL COMMITTEE
47
analysis of samples of water were necessary for the proper performance of its function by the external auditing agency.
(8)
It is necessary continually to collect, to compile and to evaluate data on water used by the public and the effect of its use upon the public health. In certain instances,
such as for data regarding the incidence of water-borne diseases, the collection, compilation and evaluation of these data is primarily a function of the health service. In other instances, the collection, compilation and evaluation of such data could better be done by the health
J. r '-<.
department in co-operation with the water agency, the census or another department. Examples of work better performed
co-operatively were the assessment of the sanitary quality of existing supplies and the determination of priorities for the improvement of proposed supplies. (9)
The health department should sponsor and be ready to assist with training and with education for water supply purposes, including: (a) pre-service and in-service training of health inspectors, sanitarians and public health engineers; (b) short courses, seminars and symposia on public health aspects of community water supplies; (c) education of the public, and ~f public officials, in regard to water supplies. Especially in rural
areas, this education should frequently be done through teachers and schools. In many countries
this education of the public, and of officials,
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REGIONAL COMMITTEE: THIRTEENTH SESSION
in regard to water supply is the most valuable fUnction that the health services can perform in this field. (10) In order that rapid progress be made in the provision of
adequate and good water to the public, it is necessary that members of the medical and engineering professions concerned with this field should respect and should co-operate with each other. (11) Increased efforts should be made to accelerate the provision of adequate and safe community water supplies. Wherever
adequate progress in this field is not being made and whenever other agencies cannot be induced to take on this work, the health department should atte~t
it.
This
conclusion particularly applies to water supply problems in rural areas in developing countries. (12) The fluoridation of community water supplies is frequently advantageous. Fluoridation, however, should not take i~ortant
precedence over more
water needs, such as those
for adequate quantity and good quality. (13) Finally, the gro~p
concluded that the system of effecting
community water supply work by a national organization set up for this purpoiie would have advantages in many countries. Such a national water works authority should be responsible to an appropriate minister and should be administered by a board upon which the health department was represented, along with other interested departments, such as the public works and the finance departments. The health department
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49/59
should be prepared to co-operate with such a national authority if such were set up, as should this national authority with the health department.