 Welcome everybody to today's webinar from Engineering for Change. We're pleased to bring you this latest webinar in E4C's 2014 webinar series. Today's webinar was developed in collaboration with Nikki Beach of NSF International and the World Health Organization and Danielle Lontang of Tufts University in the United States. My name is Ryan Rowe and I'll be moderating today's webinar. I work with the Water Institute at the University of North Carolina as a knowledge manager for water and sanitation projects worldwide. I'm just going to flip to the next slide. So I'd like to take a moment to tell you about today's webinar. Advances in household water treatment products and standards. The background here is that about 2 billion people worldwide, about 25% of the earth's population, more or less lack access to safe drinking water on a daily basis. Preventable water-related diseases as a result of this situation can claim anywhere from 1.5 to 2.5 million deaths annually. And most of these are among children in Africa and Southeast Asia. Now over the last 15 years or so, a number of products and services have been developed to allow people to treat their water at home prior to drinking. But the problem is that these technologies have failed to reach sufficient scale to reach the people who need safer water. And for our colleagues at Engineering for Change, who are the hosts of today's webinar, water is a key focus area. And they're very keen to share insights about how to scale up the delivery of these technology-based solutions. And that was the reason for why they asked us to help organize today's webinar. So E4C invited today's presenters, Danielle Lontang, who is an assistant professor in civil and environmental engineering at Tufts University, and Nikki Beach, a business unit manager for NSF International's Drinking Water Treatment Division, and who is currently seconded to the World Health Organization's Water Sanitation, Hygiene and Health Unit. So I'd like to quickly thank them both for joining us today. And before we get rolling, I'd also like to acknowledge our friends at E4C who coordinate this regular webinar series. Yana Aranda of the Association, sorry for the American Society of Mechanical Engineers, ASME, Holly Schneider-Brown, Victoria Chung, and Jackie Halliday, and Steve Welch of IEEE, who work on developing and delivering the webinar series. If any of you attending today's webinar have questions about this ongoing series, which takes place more or less every month, and would like to make a recommendation for future topics and speakers, they've invited you to contact them via the email address that you can see on this slide. That's in front of you. Just a moment. So before we hand things over to our presenter for today, I wanted to give you a quick overview of engineering for change. E4C is a global community of engineers, technologists, representatives from NGOs, and social scientists who work together to solve critical humanitarian challenges facing the world, whether in water, energy, health, agriculture, sanitation, or other areas, often faced by underserved communities. If you're interested in joining E4C and participating in this group and becoming a member, that will give you free access to a growing inventory of field-tested solutions and related information from all the members of their coalition, which includes professional societies, academic supporters, international development agencies such as USAID, as well as NGOs such as Engineers Without Borders, and practical action, and access to a passionate and engaged community that works to make people's lives better all over the world. You can register on their website, which is engineeringforchange, all one word, engineeringforchange.org, where you can sign up. So the webinar you're participating in today is just one installment of an ongoing engineering for change webinar series. And this particular series aims to showcase the best practices in thinking of leaders in the field who bring innovative technology and solutions to bear on global humanitarian and development challenges. You can find information on upcoming installments in the series, your future webinars, as well as archived videos of past presentations on their webpage. Again, that's engineeringforchange-webinars.org, engineeringforchange-webinars.org. And if you're following them on Twitter or you'd like to, you can join the conversation using hashtag E4C webinars. We wanted to give a shout out to the next webinar in the series, which will take place next month on April 29th, on innovations in maternal health. The speaker will be Meg Worth, who is the CEO of Maternova, and the moderator for the session will be Jennifer Bragan, who is a medical device management and innovation consultant. So stay tuned to their website for updates on that event that will be coming up. And if you're already a member and on their mailing list, you'll be getting an invitation to that webinar very soon. So this next slide are some instructions for folks who are attending the webinar. So we're just going to have a little bit of fun here for a moment. I'd like you to start by looking for the chat window on your screen, which is at the bottom right-hand corner. You'll see a box named chat. And I'd like you to just type in your name and the country or the city where you are dialing in from. And just give us a sense of where everyone is joining in from today. We'd like to see the diversity of participants. You can see a few countries here, Scotland, you see India, a few folks from the U.S., some from Canada. It's great to see you all here. We've got a fellow from Pakistan. So you can use this chat window to type any questions you have during the webinar. And someone will be moderating, someone will be collecting those questions and then feeding them to me as the moderator, so that when we reach the Q&A session, following our two presentations, I'll be able to select the questions and be able to direct them to the speakers. All right, so please use the chat box in the bottom right-hand corner of your screen to type in your questions. And our colleagues at E4C will be collecting those and sharing them with me so that I can direct them to the participants. Finally, number three is that this webinar is actually eligible for professional development credits. And you can find more information about that using the link that's listed there, which is engineeringforchange-webinars.org. And you'll be able to collect professional development hours for this session. So before we get started, I just want to make sure, can everyone hear me clearly? If you cannot hear me clearly, please type no into the chat box in the bottom right-hand corner. So I'm not seeing anyone saying that you can't hear me, so good. So we'll go ahead and we'll get started. Just a moment. Okay, good. So just to kick this off, I first wanted to introduce you to the International Network on Household Water Treatment and Safe Storage. The network is an alliance of about 150 organizations all over the world, which is hosted by WHO and UNICEF, and for which communications are provided by the Water Institute at the University of North Carolina. And this group of organizations aims to collaborate together towards improving access to safe drinking water through household water treatment and safe storage, or what we like to call HWTS. The acronym that we'll be using throughout this presentation for household water treatment and safe storage is HWTS, so that's one to remember. And through the network, our activities consist of working to identify and address research needs, to share the latest evidence on the effectiveness of HWTS, to promote good practice among our members, and to inform sound policy by those governments with whom we are collaborating. We have a mailing list through which we have over 1,500 subscribers, and we use that to share recent developments in the field of HWTS. We also send out a regular newsletter. We announce upcoming webinars of our own. We had a webinar last month, and we will likely be having another in the next couple of months. And we also announce workshops in different countries where we discuss implementation and policy-related issues and gather stakeholders who have an interest in that particular region of the world. Our most recent workshop was in India in November, and last May we had one in Ghana, and the previous year in Southern Africa in Mozambique, and the year prior to that in East Africa, hosted by our colleagues in Uganda. So if you'd like to learn more about the Network on Household Water Treatment, you can visit the link at the bottom of the screen there. It's a nice short URL, tiny.cc slash hwts, and that'll take you to the WTO website, sorry, to the Water Institute website, where you can get more information on the network, and you can email me at hwtsnetworkatunc.edu, and I can get you subscribed and send you all the information you need to get started. It's completely free, so I hope to see you and hear from you soon. Just a moment, next slide. So our first presenter today is Danielle Lantang. Danielle is an engineer by training and has 14 years of experience in researching and advising on issues relating to the implementation of and evaluation of household water treatment in humanitarian emergency and community development contexts. Danielle was also one of four independent experts commissioned by the Secretary General of the United Nations to prepare a report on the cholera outbreak in Haiti following the earthquake in 2010. Danielle also frequently shares her expertise at various international workshops in HWTS and has been a member of the network for several years. I'd like to turn it over to her now to present. Thank you very much. Thank you, Ryan. Can everybody hear me? Okay, that's great. So I wanted to start with a little bit of background on why we're talking about household water treatment and children in developing countries. When we look at the worldwide statistics for the causes of death for children under five years old, the main cause of death is actually, the first cause of death is the largest piece of the pie, is neonatal causes. That's the large blue square. When you then, after that, we move on to the next cause of death, and that is if a child makes it past the first 28 days, the next cause of death we have is actually acute respiratory infections. That's pneumonia, generally caused by particulate matter in the air from unsafe cook stoves. After that, the next cause is diarrheal diseases from unsafe drinking water and lack of sanitation. Then we have malaria, a mosquito-borne disease, and then measles, which is the first of these that's fully vaccine-preventable, then HIV AIDS, then injuries, and then other. What we look at when we look at this graph is that most of these diseases are actually easily preventable. We can provide adequate prenatal care and safe birthing kits to prevent neonatal deaths. We can provide clean cook stoves that prevent respiratory infections, safe water and sanitation interventions to prevent diarrhea, and bed nets to prevent malaria. It's not that we don't have solutions. It's about getting those solutions and the appropriate solutions out to people so they can use them. So why do children die of diarrhea? This is actually a picture of my son. He's six months old, and as you can see in this picture, he's not only quite cute, I think that at least, he's a little chubby. When we see a baby this fat, we generally think this baby is very, very healthy, and we want children to be that healthy because if they get sick, they have this physiological reserve to make it through their illness. So children who die of diarrhea actually tend to be the youngest children where they have an immature immune system and they have less physiological reserve. They're not this fat. Where they have multiple physiological insults, they're malnourished, they're protein and caloric deficient, they might have a micronutrient deficiency, such as vitamin A, and they're frequently infected. They might have pneumonia last week and they'll have malaria next week and they have diarrhea now. They live in a feces contaminated environment where there's feces in their water food and around them and they have limited access to effective clinical care. And so this image is a little girl from Bangladesh and she's in a very different situation than my son. Rather than spiraling up in health, she's spiraling down and she doesn't have that reserve to keep herself healthy. So when we talk about organisms that contaminate water and cause the diarrhea, there's three types of organisms. They're bacteria. Bacteria are effectively inactivated by chlorine and they're about one micron or one millionth of a meter in size. So they tend to be fairly easily filtered. And so bacteria you might heard of are cholera and typhoid. We also have protozoa. And protozoa tend to be bigger. They're about three to ten microns, three to ten millionths of a meter in size. But when they come out of the body, this is a picture of Giardia in the intestine, when they come out of the body, they insist themselves in a casing and a shell and that shell is chlorine resistant. And some protozoa you might have heard of are cryptosporidium or Giardia. And the last category of organisms that we see is viruses and viruses are generally inactivated by chlorine. They're very small. They don't have a cell wall. They're just a strand of DNA or RNA. They're less than one micron in size. And they're not generally filterable unless you have a very high quality filter. And some of the viruses you may have heard of are rotavirus and norovirus. And so you can see here that the combination of filtration and chlorination will inactivate all three classes of organisms. And that's the combination that has been used in the U.S. and Europe in the water treatment plants to reduce the burden of diarrheal disease. See that from this graph here. This is a graph from Philadelphia. And you can see that when filtration was introduced in the Philadelphia water system in 1906, there was a log reduction, a 90% reduction in the cases of typhoid. And then when chlorination came in in 1913, you again see another log reduction, another 90% reduction of the cases of typhoid in Philadelphia. And so this combination is what effectively reduced the burden of diarrheal disease in the U.S. and Europe in the early 1900s. So the question now is, in places where we cannot do infrastructure yet, and infrastructure remains the goal because of the provision of high quality water and adequate water, in places where we cannot yet do infrastructure for a variety of reasons, there's four interventions that we promote in order to reduce the burden of diarrheal disease until such time as infrastructure can be put in place. And those four interventions are here. They are the provision of water. So that's water supply. The picture on your top left is an India Mark II pump in Malawi. And that's an improved water source. And then it's water treatment at the household level, which we're talking about today. And this picture on the bottom left is a family in Haiti with a safe storage container with a lid and a tap and they're using a bottle of locally generated chlorine to treat their water. If you go up to the top right, it's sanitation provision and that's to keep the feces from contaminating the environment to isolate the feces from the environment. And then the last thing we promote is hand washing to break the oral fecal root of transmission. Now all four of these interventions have been shown to reduce the burden of diarrheal disease. There's quite a bit of debate as to which one is best or which one we should do where, but that's really up to context. Depending on where you are, you would choose which one is appropriate in the context and move forward. So we're talking about household water treatment today and if household water treatment is appropriate in the context that you are working within, there are six household water treatment options that have been shown in the literature to both improve the microbiological quality of stored household water and reduce the burden of diarrheal disease in users. And these options, two of them are filters and filters only. And so those are on the right of the slide and those are ceramic filter at the top. This is a locally made pot filter. You put it in a five gallon container. You pour water through. The ceramic is porous. The water flows through the ceramic and into the bottom of the container. A biosand filter below that, this is a larger container. It's about one meter tall. You pour water through the sand and it comes out the spigot into a receptacle. We also have chlorination, which is a disinfection only option. And so the two before filtration only, chlorine is disinfection only. And you can either have liquid or tablet or powder chlorine. The picture here is a liquid chlorine product branded zero in Madagascar. And then we have three options that remove the bacteria, viruses and protozoa. And these options are quite different. On the far left we have sodas. This is solar disinfection, putting bottles on the roof in the sun for six hours if it's clear or two days if it's cloudy. This will remove the bacteria, viruses and protozoa. And the mechanism is the combined synergistic effects of temperature increase of the water and UV inactivation from the penetration of the UV rays from the sunlight. Then we have a proctor and gamble product that's the pure purified of water. This is a sachet. It includes both a flocculant to flock out large particulate matter and a disinfectant chlorine. And so this will remove the bacteria, viruses and protozoa. And at the top left we have the Lystra family filter. And this is a filter. You pour water in the container at the top. It runs down and through gravity it flows through this filter into a storage container. And the filter is small enough that it will remove the bacteria, viruses and protozoa. So the question is when do you use each of these? And it's not that there's one of these that's most appropriate in all contexts. Depending on the quality of the water you have you might choose a particular one of these. You might also choose one depending on the local customs and the habits and what people appreciate and the way water is stored at the household and what's available on the market and what's affordable to the users or what's affordable to the donors. So it's not that any one of these options is better than the other. There's places where it's appropriate. So for example in this water which was given to me by a mother in Ethiopia as she would give it to her child you see it's quite dirty and turbid. And so in this situation you might want something like pure which has the flocculant which will remove all that dirt and the disinfectant which will inactivate the bacteria and viruses and turn that water into clear water. If you're in this situation such as a well and improved water source in Haiti where the water is already filtered through the soil you might just want to add a little bit of chlorine to that water to prevent contamination during transport and storage. Or if you're in this situation where it's a rural village in Malawi where there's no access to the market it's an incredibly rural area and these women are using these dug shallow wells in clay soil where the water is a little bit dirty and a little bit turbid but not very turbid you might either want to use something like a clay pot filter or you might want to use sodas. And so the choice of what household water treatment option is appropriate for your local users, your local context, the local water quality situation and the local costing is really going to depend. There's no one of these options that's better than any others. So what makes household water treatment work? And I'm going to give a chlorine example here but there are examples from all the different products. And I think what makes household water treatment work is to have a quality product that's distributed and marketed to the users and in some cases the people doing that marketing need to make some money on that in some cases people will distribute for free. You need to have behavior change communication and you need to have user adoption. So this is a very pretty picture of a midwife in Kenya who's using a chlorine product and you see her water is stored safely in her ceramic pot and she's using this product and she's recommending it to all her new moms to use with the water and the cleaning water for their new instance and it is possible to have household water treatment work but how does it work and when does it not work. So some of the issues we have in scaling up household water treatment is using an effective appropriate household water treatment option consistently and correctly by the vulnerable target population on a long-term and sustainable basis. So I'm going to give some examples of all of these. So effective options. You would think that every household water treatment option that we have out there that's promoted would be effective at doing what it says it is but sometimes it's not. We really want it to be effective at removing the bacteria viruses and protozoa that causes these in the lab. We want it to be field tested so that we know that users use it correctly. We want to show that there's health impact that it reduces the disease burden and we want it to be scalable. We want it to be able to reach a certain number of people and the pictures here are four products that have been given to the Haitian government with supporting documentation so that the Haitian government will allow these products to be sold in Haiti to prevent cholera but each of these products when given to the Haitian government none of these products actually contained what they said they contained and none of the companies that manufacture these products provided documentation to the Haitian government showing that they could effectively reduce the protozoa viruses and bacteria that cause disease. And so the first thing we actually need and Nicky will talk about this a lot more than I will later is products that actually work that say that they do what they do. The second thing we need is products that are used by the users. And so one thing we have seen in studies is that the longer the study is, or I'm sorry, we've seen in studies is that the higher the proportion of people that use the water treatment, so in this example across the X axis, you see it's the proportion of innovation households with detectable free chlorine. So you see when there was 100% of people using free chlorine, the risk ratio, the relative risk of having diarrhea was .5. So you see the disease reduction when people actually use the product. But in other studies where only 40% or 50% of the people are using the product, the diarrhea isn't reduced. And this makes a lot of sense if people don't like the chlorine and don't use it, their diarrhea won't be reduced. And so we need to think about what the users would like to use. We also need to think about who's using the product. This is a graph of reported adequate household water treatment use by wealth quintile. The wealthiest people are the brown columns to the right, the poorest people are the yellow columns to the left, and you can see in each of the six World Health Organization regions, except for the western Pacific on the far right, the wealthier people who have less diarrhea and who have less need for the products are the people who report using it the most. And so the most educated, the most wealthier are the most reported users, and those who are least educated and least wealthier are the least likely to report use. And so one of the things we really want to think about is appropriate distribution strategies. For example, for the wealthiest, we could have commercial products, direct sales, marketing, retail events, microenter prizes. But for the poorest populations, we want to have non-commercial distribution strategies, mass distributions, free distributions. And for those in the middle, we might have some quasi-commercial, social marketing distribution strategies. So the sense that we're... the kind of key point here is we're not going to reach the poorest of the poor, those most in need, by selling the household water treatment product. There's alternative strategies necessary to distribute to them. Another graph I'd like to point out is about sustainability of use, and we're asking the poorest of the poor, the people most in need to take the most responsibility for their water. We receive infrastructure water. It comes to our house clean, or I do, so I don't have to do anything to treat my water. But for people who have to treat their water each day consistently and correctly, what studies have shown is that the longer the length of the study, as the study becomes close to one to two years, the risk of diarrhea is not as reduced as much as in shorter studies. So what we see is people may be willing to change behavior for a short time, such as in an emergency or a project, but the sustained behavior changes is actually quite difficult. It's difficult for families to treat their water at the household level each day, every day. And so the need to establish sustainable products that are easily used by users and appropriate within the context of their water structure is key to having people use household water treatment successfully over time. So really the challenges and opportunities for household water treatment is to demonstrate effectiveness, that we achieve and demonstrate actual household water treatment and effectiveness for preventing diarrhea in large scale programs. There's been two studies, one in Haiti with the chlorine product and one in Cambodia with the ceramic filter product that have shown diarrhea disease reduction in real-world programs, long-term real-world programs. These are programs that have been ongoing for greater than five years when the study was done. So it is possible, but it's not as easy as just you hand out a product and you leave. These programs had follow-up, these programs were local, they had technical assistance, and so it's not as easy to establish that as one might think. And then we need to scale up, correct and consistent use of effective and appropriate household water treatment by the vulnerable populations, those most in need on a long-term and sustainable basis. And the end goal is to have these populations have access to infrastructure, so it's until such time as these populations have access to infrastructure. And lastly, we need to avoid diverting resources from water supply and from shifting the water burden to the poor, from asking the poorest of the poor to do the most work. There is a place for household water treatment, particularly in places that do not yet have infrastructure that are in the emergency context, where there's a need to ask users to treat their own water, but we need to make sure that we understand what that place is and target our programs to that place. So I believe that is my last slide. This is my email should you wish to contact me. And then Ryan, I believe that you have control and can shift it away from me and back to Nikki. And I wanted to say thank you so much and I look forward to reading through the questions in the chat box. Thank you very much, Danielle, for that presentation. Just want to make sure, can everyone hear me now? I'd like to see some yeses in the chat box. Great, okay, excellent. Well, thank you, Danielle, for that very informative and clear presentation. We're going to move right into our next presentation, which is by Nikki Beach. And I just want to tell you a little bit about Nikki. She's a business unit manager with NSF International. And she's been seconded to the World Health Organization to assist in the development and implementation of WHO's newly launched, just a month ago, International Scheme on Evaluating Household Water Treatment Technologies. So she'll tell you about that. During her 15 years of service with NSF International, Nikki has overseen the testing and certification of the NSF P231 Microbiological Water Purifiers Program, which was based on the U.S. EPA, Environmental Protection Agency, Guide Standard and Protocol for Testing Microbiological Water Purifiers. And Nikki has also managed the development of multiple protocols representing new NSF certification programs, which were intended for the improvement of public health and safety. So I will turn it over to her to present now. Thank you very much, Nikki. You can go ahead. Thank you, Ryan, and hello to everyone. As an implementable and cost-effective approach to improved water quality and identified by WHO and UNICEF as a key preventative component in diarrhea control strategies, household water treatment interventions play an important role in protecting public health where existing water sources are untreated, not treated properly, or become contaminated during distribution or storage. We learned during Danielle's talk that why this is so important is because every year there are 2 million diarrheal deaths related to unsafe water, sanitation, and hygiene, and the vast majority of those are deaths due to children under the age of 5 years old. As a proven primary health intervention, with studies showing reductions in diarrhea by as much as 42%, household water treatment and safe storage could offer an important interim solution for the $780 million without access to improved drinking water and the $2 billion that Ryan mentioned initially who are without access to safe and reliable drinking water. And the reoccurring message is realizing health gains does require both optimal choice and consistent and correct use by at-risk populations. But how do you make that optimal choice? To do so properly formulated and locally relevant performance specifications would be needed to protect users from informed decision-making on selection of technologies or approaches, but this information is not often available. A global evaluation of performance could provide that solution. And the demand for such an evaluation is high from governments, international agencies, donors, and based on the results of a manufacturer's survey that was conducted last summer, the demand is also there from manufacturers. The scheme, which I'm going to talk a little bit about, offers a global evaluation of performance of commercially available household water treatment products. In June of 2011, WHO published evaluating household water treatment options, health-based targets, and microbiological performance specifications, or more easily referred to as WHO recommendations. This was the first document that set forth global criteria to evaluate microbiological performance of household water treatment options. In the following year, the WHO administration approved the development of a scheme to evaluate household water treatment technologies, and this is referred to as the scheme. The recommendations in the scheme's purpose is to promote and coordinate independent and consistent testing and evaluation of household water treatment products based on WHO criteria, and to support national governments in building technical capacity of research laboratories, institutions, and especially in applying WHO guidelines in drinking water quality. The goal of the scheme and the recommendations is to protect the health of the user and increase access to safe water. The audience is governments, regulators, evaluators, manufacturers, and implementers. The target organisms chosen in the evaluation of a product's performance through laboratory testing represent the classes of pathogens in water, and just like Danielle mentioned, that's bacteria, virus, and protozoa. And the organisms that were selected for the testing are valuable in that they are well documented as laboratory test organisms. They have varying degrees of susceptibility to commonly used drinking water disinfectants like tryptosporidium, as Danielle mentioned, represent an array of particle sizes and surface properties, or are actual pathogens in and of themselves. Detailed information about the testing, including the specific test organisms, can be found on the scheme website, which I will share that link at the end of my slides. The target for performance requirements were based on the guidelines for drinking water risk-based approach, and there is a tiered approach for claims under the scheme, and this is based on performance, and these are highly protective, protective, and limited protection, originally termed interim in the document published in 2011. As I mentioned, the claims based on the laboratory testing is based on the performance as reduction or inactivation of the three classes of organisms. The highest level of performance, highly protective, requires four-log reduction or inactivation of bacteria, five-log for virus, and four-log for protozoa, and that is all three organism classes must meet these levels of performance. Technologies that may be able to achieve this level include boiling, ultra filters, or perhaps a combination of technologies. For a protective claim, the product must achieve two-log of bacteria reduction or inactivation, three-log for virus, and two-log for protozoan cyst. Again, the product must meet all three classes to this level for this claim, and technologies that may be able to achieve this level of performance may include membrane filters, flocculants, disinfectants, combinations, and the lowest level of performance for a claim, limited protection. What is required is there must be the demonstration of any two of the classes of organisms to the protective level. Technologies at this level might include chlorine, ceramic filters, biosand filters, and because this does not require some performance for all three classes, this claim will be supplemented with language that allows the user to know the two classes of organisms that have met in which remaining class is not addressed by this technology. The scheme will allow for informed selection of products with demonstrated performance. However, as has been mentioned several times, to realize optimal health gains, selection of appropriate household water treatment products must be in tandem with consistent and correct use. Household water treatment products will only realize optimal health impacts if consistently and correctly used at the at-risk population. And for this reason, there's a mission to promote household water treatment and safe storage as a key component of community-targeted environmental health programs. Why integration? Because studies have shown that integration works. To make the most of the scheme and the recommendations, efforts will be dedicated to strengthening the national capacity, including training officials in risk-based assessments, strengthening national laboratories and equipment to conduct complementary testing. The testing is very complex, and at this time there's a few laboratories with the capabilities to perform this testing. The goal is to increase the number of laboratories that can perform this testing. And a critical component is effectively communicating claims based on testing performed at qualified laboratories. That will be key. And there are those three claims available. So communication is really important because of the complication of having the three claims, but having the three claims does really allow for incremental improvements and other benefits. These efforts will empower those in the position of making the purchasing and approval decisions, national certifiers, regulatory authorities, researchers, non-governmental organizations, and implementers to choose technologies and products based on the needs of their jurisdiction. Here I've provided the link to information on the scheme, and there's a lot of information there. If you want to see a generic harmonized test protocol, you can take a look at the organisms that are used, the test approaches that are used, and some other great information about the scheme. As Ryan mentioned, this was launched about a month ago. We just finished submissions for round one. So this fall you should see listings of products on this website who are now under the scheme. Thank you. Thank you very much, Nicky. Okay, great. So just to wrap up what we've heard is Danielle Lantang kicked off the webinar giving us an overview of the key challenges to scaling up HWTS. In particular, she had a slide in terms of effective options, and she listed four steps in terms of evaluating the effectiveness of an HWT option. And then we heard in the following presentation from Nicky about a new scheme from WHO which aims to facilitate the evaluation of HWT options globally to be able to understand which products are effective and the extent to which they are able to improve the quality of household drinking water using health-based performance targets. So I'd like to open up the question and answer period. You're going to see a box in the right-hand bottom corner of your screen that says a little question mark next to it says Q&A, and you'll see an arrow next to it, sort of like a little triangle. If you click that triangle, it should open up, and in that box you will be able to type your question. So I would like to encourage you to please submit your questions there so that we can take them in the order that they're received and to the extent that we feel that there's a general interest in having that question answered. In the meantime, I've been trying to keep track of all the questions that you've been asking at this point. There was a question about using moringa seeds to purify water in a rural community, and there was also a question about the Sawyer 0.1 filter, and I wanted to refer those two questions to the Household Drinking Water blog that is moderated by Dan Campbell with FHI 360. This is a Wash Plus. The project is known as Wash Plus. It's being funded by USAID, and they have a blog, and I'll give you the address for the blog so you'll be able to check it out. The address of the blog is WashPlus.org slash Drinking Water Updates, and I've pasted the link into the Q&A box so you should be able to see that. And if you go there, you can use the blog to search through recent studies relating to moringa, olefera, and the Sawyer filters. So hopefully your questions will be addressed there. In terms of... I've got a couple of other questions here. One question which is quite interesting, and I'd like to direct it to Danielle. The question is, is the lack of safe water primarily an education slash behavior issue, or is there a technological deficiency? So, Danielle, if you wouldn't mind maybe taking a stab at that question. I'll pass the mic over to you. Thanks. I think I'm going to answer that question by saying it's both. I think in the experience of the U.S. and Europe, we didn't work on education at the individual level. We simply provided people infrastructure water with a very high chlorine content in it and said, this is your water, drink it. But in the event that we can't do that, where we can't provide infrastructure, we do need to provide education in order to use a household product where we can't do the technology of infrastructure, we do need to have... it's a little bit about both of the technology and the education. It's the education to show why it is important to treat water, that it does cause disease, that diarrhea in children is a problem, and that can lead to long-term impacts. But it's also technologies that are appropriate for use in the household. There's a lot of technologies that come through. I've developed something new, a new filter, a new this in my lab or my garage, and the real answer is that we need to have technologies that are developed in conjunction with users so that those technologies are usable by the users. It's not just that they can meet these criteria that Nikki has established, but they're also usable. And just to say, there's been a couple of questions that I saw that I'll adjust quickly. As far as I know, the Sawyer filter has not yet been evaluated. I hope it's one of the products that Nikki is able to evaluate in her scheme. There's a lot of interest in it, but I've not seen long-term evaluations. There's clearly a lot of people that are interested in promoting it, and we need some long-term evaluations of that product, I think, because it's a potential new product on the market. Meranga is effective at reducing the turbidity of water and removing some of the bacteria, but not all of it or complete treatment. And boiling is very, very effective. I've seen some questions going on there at removing bacteria, viruses, and protozoa, but does require a fuel source, which can be difficult for some people, depending on what your fuel source is, and also can become recontaminated in storage if it's not safely stored. So boiling can be a great option in places like Indonesia, where people are using propane for cooking and have a propane cook stove, and it's probably not a great option in Haiti with the deforestation and people cooking on charcoal. Again, it comes down to context, and depending on the context, boiling can be a great option, and it can also be not an appropriate option. Ryan, I'll turn it back to you. Thank you very much, Danielle. I'd like to direct a question to Nicky, and the question is, how will the scheme deal with household water treatment options, which are developed locally by sort of community-based solutions and organizations in a country? I'll pass it over to you, Nicky. Thank you. How would a locally manufactured product be evaluated under the scheme? Is that the question? Oh, okay. You dropped out for a second there. Sorry. There would be a submissions round, and we did see situations like this in our recent round, and information about the product would be submitted to the scheme, and the way the scheme is set up is that there is a laboratory test that is to mimic what might be seen in actual use. So this product would be tested like any other product that would be submitted to the scheme for testing in this laboratory type setting, and the really great thing about the scheme is that it allows for a lot of portability of the data, because the data is performed in the laboratory under very prescriptive test parameters that are with the protocol being written in such a way that it should be suitable for most places that the product may end up. So the scheme is really set up in a way to allow for that portability, so it's not so much focused on testing the product for its suitability in a specific situation. It is testing it to the laboratory test, and that information and that claim associated with it with knowledge about what your local needs are would be how you would make selection from products that have been tested under the scheme and approved under the scheme with various claims. Does that answer your question? Yes, thank you very much. I think that the important part is the national capacity building, working with local governments to assist them in developing nationally appropriate and contextually relevant standards. Is that not right? Yes, that's absolutely correct. The audience for the scheme is not necessarily user, but these other people who are making decisions about what can enter an area, what can be sold in an area, or what's going to be purchased and distributed to an area, and hopefully there's going to be some information about what will be used, what would be well received, and also what would be adequate, suitable for what their water quality needs are. Thank you. Okay, so a related question, and I'd like to direct this one to Danielle, is there's a lot of silver bullet solutions out there which claim to be the great sort of solution to providing safe drinking water for folks who don't have access to it on a regular basis. And in the absence of those products being tested by the WHO scheme, and an NGO or a community wanting to introduce those, how do they know that that product will actually work in their community? What are the four steps that they should follow? And I guess, just to make my question more clear, is you had a slide on effective options in which you listed four steps. Should those four steps be used for every single product every single time? And if we can't afford to do that, which ones are the most important? Danielle? Right, and I think that the first step in terms of a product is we need to know if it reduces the bacteria, viruses, and protozoa that cause disease. I think that's a laboratory step, so I don't think that needs to be done in each context. And sometimes that's done according to the scheme and sometimes that's done in other contexts. We should know that that happens at an international level. For example, we know that the pure proctor and gamble product reduces a certain log of each of those categories. Now within the local context, I think what I would recommend is, one, you ensure the product that you're obtaining locally is actually what it says it is. So you know that what you have in the context, if it says it's 0.5% chlorine or 0.1% silver, you do a verification step to make sure that what you're receiving actually is what it is. There's a quality control and quality assurance piece. So the first is this international certification. The second is this local quality control piece. And then I think it's really the next step of is this the appropriate option for the people you are trying to reach. And so I've seen some questions about, you know, some people object to chlorine taste. Is there a way to mask that? The reason chlorine is so effective is because it is so reactive and unfortunately we do not yet have a way to mask the chlorine taste. And if users do not like the chlorine taste, then that's not the option for that context, right? Or it's too complicated to use if people don't have the equipment necessary to use it. I think in every option I've walked in, this is a ceramic filter example, but I walked into a household once and asked if they were using their ceramic filter and they said yes. And I said, okay, can I please see it? And they reached under their table and they pulled their ceramic filter out and it was full of their dried beans. They felt it was a better dried bean holder than a ceramic filter. And I think we've seen that with all the options, just not the appropriate thing in the household. So I think it's a mix of taking these international standards or equivalent laboratory data so that you know the option can be effective and then confirming that that's the option you actually have in your local context and then ensuring that that's the right option for the user that you're working with. It's not about... I see a lot of programs, you know, I have a friend who makes a filter and I have a friend who works with the community in Country X and I'm going to give this filter to this community and that's not how to do it. How to do it is to understand what the community members would like and then understanding something about the cost and the scalability. So how are users going to pay for this or how is this going to be funded? And I noticed one of the questions was about funding and these are funded in different ways. Some of these are straight up donations that simply an organization will give away the products. Filters are more often donation products, chlorine, although these are very rough generalizations because the filters are generally a one-time fixed expense that may be too expensive for users to afford, whereas chlorine, sometimes users can buy it on a repeated basis and it's less expensive so it can be a socially marketed intervention where people buy it over time. There's benefits and drawbacks to both of those because something that there's not a supply chain for, if you give someone a filter and there's not a supply chain for replacement parts, there's no sustainability and people having to buy something once a month can be hard both cost wise and remembering to do it. But so there's different models of either social marketing or free or mostly subsidized distribution but there needs to be a model that it will be continued under. So what is your plan for costing over? And I'm agnostic on this. I don't care if your plan is to give out money to give it so you give out more things or if you have some kind of cost recovery strategy over time. And then the last thing, and this was in the slide as well, is the sense of scale. If we have the perfect product and give it to 10 people, it's probably, it's nice for those 10 people or families but really this is a problem, as Nikki said, of almost 2 million deaths a year and 2 billion people without access to safe water. So that's what we've taken to scale. So from my perspective, it's a continuum from these international standards to quality control checks to making sure it's the right option for your users, chatting some type of mechanism for understanding what your cost is going to be and how you're going to handle that to thinking about your scalability and your sustainability. Does that answer your question, Ryan? Yes, it does. Sorry, I'm trying to get the mute off. I have another question to follow up in your slide that you mentioned vulnerable populations. And then that was at point number 2, I believe, in terms of challenges to scaling up HWTS. So targeting vulnerable populations. And then number 4 was about long-term sustainable use. And so when I think of vulnerable populations, sometimes I think of groups that may not be capable of paying for a product even though they need it to improve their health. So how would that work? Thanks. That's for me. So the first thing is when I talk about vulnerable populations, the people who die of diarrhea, children under 2, immunocompromised, elderly, generally diarrhea does not kill the kind of healthy adults. And cholera is an exception to that, a notable exception. But those vulnerable populations, and those vulnerable populations are more vulnerable if they're of lower socioeconomic status, if there's less resources in the household able to go to them. And in many cases, these aren't the economically productive members of the household, sometimes there's not as many resources available to those members of the household. So when I talk about vulnerable populations, those are the populations that I'm talking about that we really want to reach, to actually reach the people who are dying of diarrhea. And how do we do that? It's about making sure that those populations receive resources. They're considered people that can get resources. A lot of families will tell you, all kids have diarrhea. It's normal for kids to have diarrhea. It's not actually a problem. It's something that childhood diarrhea has long-term economic impacts and trying to see if it's possible to value that or provide subsidies. So that is valued. And continuing it, my sense is we should never be thinking of household water treatment as the ideal long-term solution. Right now, 90% of the U.S. population has access to pipes treated, centrally treated, infrastructure water. That would be the goal. Now, there's 10% even in the U.S. of people who use private wells or private sources or water trucking or community wells. Not everyone can be reached, but my sense is we shouldn't be looking at household water treatment as the national-scale answer. We should be looking for targeted programs to HIV-positive people, children under two, and poor families that we really want to reach to reduce the disease burden. Did that answer your question, Ryan? Yes, it does. Danielle, thanks. You're talking about targeted programs. And I link that to Nicky's slide on integrating household water treatment with other interventions. You might recall on anti-natal care in Malawi, for example, HIV and Zambia using insecticide-treated bed nets and integrating that with household water treatment. And I think the integrated approach is one of the core focus efforts of the network on household water treatment. I'd like to direct a question to Nicky, and I'm sort of basically thinking in context of the people who are in this webinar right now. There's a lot of people coming in from overseas. Nicky, for those who are working on water quality and safe drinking water issues at the national level or at the local level in countries like India and Pakistan, for example, can you specify what could they be doing to help advance efforts in their countries? That's the first question. And the second question is, are there countries of priority for the development of national standards from WHO's capacity-building perspective? So two questions for you, Nicky. Thanks. I'll start with the second. Part of the submission, when we had the call for submissions for evaluating which products will be tested under the first round, things like location of manufacture, location, target location, marketing area, where the products are intended to go, scalability, those sorts of things weighed in to the decision about what were priority products that needed to be tested or perhaps provided with some subsidies that were available. So there definitely is some emphasis on doing some testing and making efforts and putting a priority in getting evaluation of products that are in these areas of greater need. And I'm really excited at learning more about how we are going to provide this educational piece with national regulators and such. And I wish I had a million things I could tell you right now. We just have the call for submissions. We're just in the point now where we're starting to do some testing and the next focus is really going to be how we are in these decision-making places. And I think joining the listserv and having the information and being knowledgeable and starting to put some pressure even on manufacturers in terms of making them aware that this program is important would be some first steps. The best I can say is I'm going to be learning as well about how we reach these populations. You know, definitely there will be a plan in terms of which areas sort of are considered more urgent in terms of reaching. Thanks, Nikki. So Nikki mentioned the listserv in her answer just there. And she's referring to the mailing list for the international network on household water treatment and safe storage. And again, if you want to get involved in the network, then I'm just going to quickly go back to that slide. If you'd like to subscribe to our mailing list, you can send us a message here. Just going a bit slow, sorry. There we go. So at the bottom there you'll see a link to which you can learn more about the network. You can email us to subscribe to our mailing list and receive our periodic newsletter. Now both of the issues that... Oh, right. Oh, I'm sorry. I'm saying I'm sorry. And you know, I should have added this too. Just the idea of integrating with other programs that are sort of already have a strong hold on getting to the ears that need to be gotten to. So I'm sure that's going to be a really great opportunity for us to build more awareness of the scheme. Sorry for the interruption. No, no, no problem at all. So these issues that Danielle and Nikki have been discussing, we touch on these in detail through the activities of the network. So for example, the issues that Danielle was speaking about relating to scaling up of HWTS and then evaluating which options are effective and going through those different steps, we touch on these through the various workshops and webinars and our newsletter materials on a regular basis. And then in terms of the scheme, which Nikki has been speaking about, we had a webinar on the scheme which went into greater detail about a month ago and we have received a lot of questions on the scheme which are similar in some respects to the questions that have been asked today. And we are addressing those over the course of the next few weeks in preparing a compiled list of Q&A. And so we use the mailing list as a mechanism for engaging with the community on these issues and trying to make sure that all of your questions are addressed. So I think there... Maybe I'll just touch on... There was one last question which I wanted to direct to. There's a question that was submitted a couple of times. Are there opportunities for inexperienced engineers to get involved in these sorts of projects? So as, for example, internships, and I guess if there are some students in the audience or some young professionals, both Nikki and Danielle could address quickly as we're just running out of time. Thank you. I would say a great place for engineers to start getting involved with projects like this is through Engineers Without Borders. That's a great organization for a place to start and there's student chapters and professional chapters. And it's Engineers for Sustainable World. It's also another program. So that's probably the place I would start. Thank you very much, Danielle. So Engineers Without Borders. You can have a Google search for them and find them and they have chapters all over the world if that's an organization that interests you as a young and inexperienced engineer looking to gain the expertise that that might be one option for you. Nikki, are there any opportunities for students or young professionals to get involved in sort of either work with WHO or at the local or the national level in terms of the organizations that might be helping to advocate for uptake of the scheme or national standards? Any ideas? I can't think of anything beyond what Danielle has already mentioned. And, you know, I do apologize. No, that's okay. I mean, I think it's good to kind of be tossing about some of these ideas. I would suggest that anyone who is looking to gain experience would first of all subscribe to the network and be in touch with me. My name is Ryan Rowe and I handle the communications for the network. And I do receive oftentimes inquiries from different organizations just looking for expertise. And I'm also, if you have a particular interest, if there's something that you're interested in learning about, for example, delivery of rural water supply or if you're interested in learning about water quality testing I have a pretty good sense of what's happening out there and which organizations are the leaders in these areas. And I'd be happy to refer you to contacts and resources that might be able to assist you as you engage in professional development. So it's 10 past 12. We've gone a little bit over time, but we did that because we had a little technical difficulty at the beginning. So at this point, I'd like to wrap it up and thank you all for your participation. A recording of the webinar will be online within, I'm told, within a week or two, I believe. And I also I see that Holly is just taking control of the presentation. She's moving it to the last slide. So there's the website. You can visit engineeringforchange-webinars.org to find a copy of this recording of this presentation of this webinar. It's also available or eligible for professional development credit through engineeringforchange. And if you have any questions, you can also email them directly. And don't forget to become a member. It's free and get info on their upcoming webinars. Well, thank you very much, everybody, for participating. We wish you a happy and productive day. Take care. Bye-bye.