 Good day everyone, and thank you for joining today's Iowa webinar, which is looking at safely managed sanitation, introducing the new WHO learning package. So just some background information on the protocols for the webinar. So this webinar will be recorded and it will be made available on demand on the Iowa Connect Plus platform, the presentations and slides, and all other information. So the speakers are the ones who are responsible for securing the copyright conditions for any work that will be presented. The opinions, hypothesis conclusions or recommendations containing the presentations and other materials are the sole responsibility of the speakers and do not necessarily reflect Iowa's opinion. So for feedback or questions, there is a chat box, and there's also a question and answer box. So please use the chat box for general requests and interactive activities. And for the question and answer, you can use the Q&A box to send the questions to the panelists and they will be answered during the discussions, and also in the post webinar materials. Just to give a background, what the sanitation program is like, we're doing this under the inclusive urban sanitation, which is an Iowa initiative to reshape the global urban sanitation agenda by focusing on inclusive sanitation service schools and the service systems required to achieve them. This is looking beyond infrastructure and technology. So it's meant to engage the public, the private and academic sectors to share their experiences and define global goals and fundamentals of the public sector approach to service outcomes, also known as citywide inclusive sanitation. The initiative is being progressed through a senate action campaign, which is Iowa's global call to action on inclusive urban sanitation. So so far an advisory board and task force have been formed to spearhead this program. In terms of what is happening as well. The aspects of safety, inclusivity and multi technology dimensions are being fully integrated into the urban sanitation concept worldwide. This means that the concepts and norms are being defined and also for SDG6, as well as these dimensions being mainstreamed within Iowa's knowledge creation instruments and dissemination channels. So the citywide inclusive sanitation framework considered within the international sanitation community and beyond through Iowa's communication channels. So that is the whole drive for the service framework. So far, the actions that I was planning is that they should be an Iowa journal on special issues on inclusive urban sanitation and other publications focusing on low income countries, including white paper and position papers. There are also webinar series, this is one of them, and learning sessions included focusing on trainings and MOC's. There are blog stories series including podcasts and documentaries you find the stories online on inclusive urban sanitation from a number of countries. So the launch of a biennial innovation conference and inclusive urban sanitation champions program at the Water Development Congress and exhibition in Gigali from 10th to 14th December. And also consultative process which is globally acceptable series framework, and also assessment guidelines. So this are being developed through consultative processes. So this is our initiative for inclusive urban sanitation. Now coming to today's webinar, which is looking at the WHO learning package. The agenda is basically looking at part one, there's several parts to this. So on the part one we have the health rationale for safely managed sanitation. Then the third part is looking at the four key recommendation of the WHO guidelines, followed by how to embed safely managed sanitation in national systems. Part five is risk-based tools to implement safely managed sanitation planning and also risk-based tools to implement SMS through sanitary inspections. And we will have pause and quizzes during this webinar so please pay good attention and let's see who gets it right. So we have a very gender balanced team, all female, giving us the presentations. Kate Medlikot, who is the sanitation team leader within the WASH team. We have Sophie Boyson, who's the technical officer in the team, but Sirai Majuru, also a technical officer in the WHO team. Yonella Dillon is Sanitation Safety Planning Consultant for the WHO and she's been involved in several trainings and we have two experts joining us on the panel. Charlotte, who's an environmentalist and program manager in Ghana, and also Dr. Vijay Sharaseya, who is a joint advisor in the government of India. So I will be handing over the button to the team as we look at the learning objectives at the end of the session. We expect that the participants should know the health rationale for safely managed sanitation, understand the key recommendations of the guidelines on sanitation and health, and know where to find monitoring and implementation definitions for safely managed sanitation in each step of the chain, and have a better understanding of where and how to embed definitions international systems, and also have an introductory understanding of risk-based tools to implement safely managed sanitation. There will be also information on where to find more on these guidelines, trainings and tools. There are also key resources available online and we will be able to get the links to these resources for the guidelines, the sanitation safety planning, and sanitary inspections. So to begin, the learning is Kate's magic card over to you on the health rationale. Thank you, everybody. It's wonderful to be here. Let's get going. So we are WHO, so I'm going to start on the health rationale and answering the question, why do we need safely managed sanitation? Why has the goalposts shifted from ending open defecation? So we can think about the health impacts of poor sanitation in three categories. The first is infectious disease, particularly diarrhea and cholera, which is raging at the moment. Helmet infections, those are intestinal worms, and also insect and vector-borne diseases that like to breed in theses and wastewater. Secondly, we have the consequences of those infections, so things like stunting, impaired cognition, pneumonia and anemia. And then more broadly, as WHO health is not just the absence of disease, but also broader wellbeing. So the impacts on school attendance, for example, anxiety, shame and so forth that's associated with privacy. So with all of these impacts in mind, how have we been doing? What we can say is that we know sanitation is meant to deliver cost-effective health and economic benefits. But when we look collectively at the evidence, which we did kind of looking at over a thousand papers as part of the guidelines on sanitation and health, what we found is we're not having as much impact as we might like. So we need to move to safely managed sanitation to ensure that we're reducing health risks and delivering real health impact with the investments we're making in sanitation. So let me show you a little of the epidemiology. This is a paper that came out a few years back. And what you see here, each one of these dots is a major epidemiological study looking at health impact of water and sanitation. Where this line is here at one, it means really there was little or no health impact associated with this intervention. And what you see on the bottom is what the conditions were like at the end of the study. So 16 is being a very dirty environment and two being very clean. What we see is when, until we get a very clean environment, we get little health impact. But then when we're getting to that, that's finishing the job, we see these health impacts arriving. And that's why we need safely managed sanitation. I'll explain more. So many of you will be familiar with this old F diagram, which has been very helpful in getting us to think about how disease transmission happens from one person practicing open defecation to a new host. However, it has some flaws, in fact, because sanitation is more than a toilet. We know that it has the service chain, which is the toilet, containment, conveyance, treatment and use and disposal and with that great opportunities for circular economy and reuse. And notice that many of those parts past the toilet are not in control of the household. So when we look at the new F diagram in the guidelines, what you can see is we unpack the sanitation service chain and make it clear that these hazards exist all the way along the sanitation chain, not just at the toilet, but risks that can occur at all of these steps. So what I'm going to show you now is to demonstrate some of these risks using what might be familiar as an excretive flow diagram. So coming in on the left side we see different sanitation service types, sewered, non sewered or lack of sanitation, which has opened defecation and risks that can happen at that point are things like a lack of toilet or dirty toilets and no hand washing facilities. When we go to the conveyance step, we see additional risks such as faecal sludge spillage during manual or motorised emptying or septic tanks that are full and overflowing into the local environment. At the conveyance step, we might see leaky or overflowing sewers, we might see dumping of faecal sludge into local water bodies or directly onto farms. And at the treatment step, we might see poor functionality of treatment plants or lack of treatment plants altogether or poorly matched treatment levels with the intended reuse done downstream. So I hope this gives you a flavour of why we need safety managed sanitation and the risks that can occur all the way along the sanitation chain. As we go into the next presentations, we'll unpack this further. So at this point, I'd like to hand over to my colleague, Sophie Boisson, who's going to talk about definitions. Sophie. Thank you very much, Kate, and great, great to, it's a pleasure to be here with everyone. So following from Kate's presentation, so what counts as safety managed sanitation? So I'm sure most of you are familiar with this figure by now and this is the WHO UNICEF joint monitoring program service ladder on sanitation, which is currently used to monitor progress against SDG target 6.2. Compared to the one from the MDG period, this ladder includes a new run of safely managed services. So to be defined as safely managed, people need to be using an improved sanitation facility that is not shared with other households, but also which ensures that the excreta collected remain isolated from human exposures. And this is defined in three ways. So excreta can be transported through sewage to a treatment plant. This is what we call a wastewater treated off site. They can be emptied from a local storage pit or tanks and conveyed to a treatment plant and we call that emptied and treated off site. Or they could simply remain in the ground and eventually be treated and disposed of in situ. While this definition is very useful for monitoring purposes, when it comes to programming, we need much more nuanced definition. So in the guidelines on sanitation and health, you will find more detailed information on what safe means at each step of the sanitation service chain from toilet throughout to to end use and disposal. But the three includes considerations on design and constructions on operation and maintenance, as well as some incremental measures. So these definitions are really designed to guide program implementation. But I just wanted to emphasize that they are completely in alignment with the measurable definitions that are used for SDG monitoring. Now we'll hand over to even who will take us through the first quiz over to you even. Thank you very much. You've heard from the two presentations. And now let's check if you have picked some information from the two presentations through a small quiz. So there are three questions in this quiz. When you see the quiz on your screen, you pick the correct answer and just scroll down to the next question until you finish and submit. So the first question along the sanitation service chain failures put human health at risk failures which put human health at risk. I must like it to occur where so you have to choose one. Is it with a toilet during containment during conveyance during treatment during end use or disposal or any of the above. One question. What is the gen P definition of safely manage sanitation for global monitoring of SDG 6.2. What is the SDG definition, the gen P definition of SDG 6.2 is it use of improved facilities shared between two or more households of pit latrines with slap or platform hanging or bucket latrines use of improved facilities which are not shared. Use of improved facilities which are not shared with other households and where it's treated as safely disposed in situ or removed and treated upside or dispose of human feces in fields forest bushes. The third question. How are the definitions of safely manage sanitation and double it shows guidelines on sanitation and health linked to the gen P definitions of safely manage sanitation. Only one choice provides more detail on design operation maintenance for implementation. Define what safe means at each step of the sanitation service chain online with the gen P definitions, helping understanding what it's most relevant for monitoring locally or all of the above. So, I hope you've got your answers and you've been able to answer the three questions. Now, I think in the next few seconds we close the quiz. And we see what the correct answers should be. And most people answered the 88% I'm disappointed with my participants, the correct answer is F, which is all of all of the above. Because failures at any step of the sanitation chain can result in negative health outcomes so most of the chain is outside the direct control of the householder. So it's critical that all actors including local national governments and the private sector do their part to ensure that the risks are managed along the whole sanitation chain from beginning to end on question three. The answers were for E, all of the above, and only 1% answered correctly, which is D. The answer is use of improved facilities which are not shared with other households and where excretion simply disposed in situ, or removed and treated So that's the JMP definition for SDG 6.2. Did I mix them up? Ah, my bad. Okay, so now most of the correct answers were actually F, D, and number three is E. I had looked at the wrong question. So thank you so much for answering correctly. We move on to the next presentation, which is onto the next presentation. Thank you so much. We are now looking at the four recommendations of the WHO guidelines. Sophie, back to you. Thank you, Yvonne, and well done participants for this first quiz. So as we've heard earlier from Kate's presentation, we know that current sanitation efforts are not achieving the health game that we would anticipate. And so the question is, what, what really needs to change. So in the WHO guidelines on sanitation and health she will find four key recommendations. So let's unpack and let's unpack each of the recommendations. So let's start with recommendation one which is really focused on safe toilets. So, so to improve health, well-being and human rights for all, we need to ensure that toilets are used by everyone in the community. There is evidence that law or partial coverage still means people are exposed to the excretion of others that do not have toilets. So no one is really safe until everyone is. I must say, though, that dignity, human rights and well-being benefits are achieved for those that have toilets. The second point is, is to highlight that while individual sanitation is the goal in some places, we know that shared or public toilets may be the only interim option to make sure everyone has a safe place to go. The third, the third element is, is really highlighting that toilets and containment should meet some minimum safety standards. In fact, going from open defecation to an unimproved toilet is not likely to improve health impact. In fact, it could make the situation worse in some cases. And likewise, we need to ensure that pits of septic tanks don't pollute the groundwater or the local environment. The fourth one is, it's important to work on creating demands for toilets. So as we know, the CLTS is a classical example where we need to conduct behavior change programs, but at the same time, we need to ensure that there's a supply chain to meet that demand by supplying safe, affordable and desirable toilet options. And lastly, we need to be thinking about the places where people need to use a toilet as they go about their daily life. So whether it's at home, at school, in healthcare facilities, at work, or in public places. So recommendation two is focusing on the whole sanitation service chain. And we know this is where we get the major health gain as this was highlighted in previous slides. This is especially true in urban areas. So we know that most of the sanitation chain are actually outside the control of households. So households can't really do it alone. So we really need to consider what happens after the toilets. So for example, we need to be thinking about, you know, does the containment provide treatment on site? Will it need to be emptied? Who will empties? Are there, what kind of emptying services exist? Where will the waste go? And does a treatment plant even exist? Does it function? Does it have sufficient capacity? We need to remain technology agnostic. So we know that there's a lot of technologies out there which have strengths and weaknesses, depending on the context in which they operate. And we really need to try to avoid picking a silver bullet technology or services. Really, we really need to keep an open mind about technology solution as long as they meet minimum performance standards for safety. We all know that often we can't do everything at once. So it's important to identify the highest risks that affect the most people and work on those first. And we'll hear about this a bit more in the next few slides. And finally, we have to remember to include the workers. Safely managed means that people are doing that management and sanitation workers are especially important. We know that informal workers often work in horrific condition and safely managed sanitation really means that we need more of these workers and they need to have a safe and dignified employment. Recommendation three recognize that sanitation should be delivered as part of local services. So in order to achieve efficiency, it needs to be coordinated with other local services, such as housing, transport, solid waste management, for example. And in order for sanitation to be sustainable and deliver health impacts, we need to ensure that sanitation interventions are coordinated with other interventions such as water supply and hygiene in order to have the most health benefits. Recommendation four focuses on the role of the health sector in sanitation. We all know that many aspects of sanitation services delivery and oversight are delivered outside the health sector. And this is fine because the health sector is not well placed for example to build infrastructure or to manage vehicles such management services, or regulate tariffs. There are six critical functions the health sector must fulfill to ensure sanitation protects public health. So first is contributing to sector coordination so not necessarily leading but ensuring that policy and plan support national health objectives. Similarly, the health sector should contribute to developing sanitation related norms and standards. For example, standard designs and performance criteria for treatment these are devices to ensure performance, effectively interrupt disease transmission. Specifically, the health sector should need on making sure sanitation is included in health policy and program where sanitation is needed for primary prevention. Kate mentioned earlier cholera and that's a classical example. But also making sure that sanitation status is included in the health survey and system to target investment in high disease burden areas. Finally, ensuring a sanitation promotion within health services and also ensuring that healthcare facilities have adequate sanitation facilities for patients staff and carers and that they are connected to save sanitation system for treatment and disposal. With that, I will stop and I will hand over to my colleague but seem a jewel for the rest of the presentation. Thank you Sophie, and a very good day to everybody's draining us today. So Sophie has talked about what safety management sanitation needs and Kate talked about why it's important. And I just want to take it a step further by talking about how we can start to embed safely managed sanitation into our national systems. And I think we're all aware that one of the challenges that the sanitation sector faces is fragmentation amongst government levels so with a national local government, but also even across ministries and across the service providers themselves. And so safely managed sanitation means that we need to be delivering our sanitation services as part of a coherent implementation framework, where there's a clear delineation of functions at the various levels of government. But also more importantly at local government is that real interface with the users at the local level where services are being accessed. So if you think about infrastructure, for instance, sewage networks will require huge investments normally from national government or even from regional and external entities. So having that level of coordination is absolutely vital. But then now when you start to think about okay we've got our implementation framework what targets do you want to set for sanitation. The key message to emphasize that we need to set targets that are realistic, but also ambitious. So on the figure you see that there's the figures outlining progress towards safely managed sanitation by 2030 by region. And what you will note is that there is no region that is actually on track for achieving this target of safely managed sanitation for all. And actually for that to happen for everyone to have safely managed sanitation at the current rates of progress would actually need to quadruple. And that is a huge, huge change that will be required. It's a huge challenge for a lot of countries around the world. And realistically speaking, it's not going to be possible for everyone everywhere to say that by 2030, we will all have safely managed sanitation. And this is where it's important to take stock of the current situation, be very realistic about existing resources, and also put some ambition into what can be done to accelerate progress. And we also need to be bearing in mind as we think about our setting our targets for safely managed sanitation is that actually onsite sanitation is growing quite rapidly. And in fact it's growing twice as fast in urban areas compared to rural areas. So while it might be okay to have onsite systems with disposal of excreta in situ in rural areas, in urban areas this might actually be posing a challenge. So when we think about in future those sanitation systems will need to be emptied or need to be conveyance and prefront without the adequate infrastructure and investment now for all of that to happen. That will be a major challenge. So as we think about what targets you want to set for safely managed sanitation we can go back to this service ladder that Sophie shared earlier, and think about how we can progress from the yellow and orange rungs of the ladder. So these are the rungs of the ladder that we want to move from to the green rungs of the ladder that actually represent safely managed sanitation. So a target example could be for instance, eliminating open defecation by 2030 and having at least x percentage of the population having basic sanitation and having certain percentage of the population having safely managed services. And also to be clear that when we say safely managed again this is not to say that everyone everywhere is going to have sewer connection safely managed can also mean that there is safe disposal of that excreta in situ or onsite. But the point is it is safely disposed and separated from human exposure. And to think about how we can set these targets. What is really important is, again, having a robust assessment of the current situation and understanding what resources there are to move forward. And at this point it's really helpful to apply a risk based assessment and such risk based assessments could use various tools such as the excreta flow diagram that Kate showed earlier, where we can really start to think about where the operators risk our caring along the sanitation service chain, and where we want to target those improvements in the sanitation service ladder. We can also be applying a different kind of tool for instance when we want to think about how we prioritize elimination of certain diseases so we think about overlaying coverage of sanitation for instance, for instance, with prevalence of sanitation related and target those areas that have the highest prevalence of disease for improvement, or equally there could be some other method of disaggregation where with such as poverty, geography or ethnicity. But the point is there is a systematic and robust tool or approach that is being used to understanding how we target areas for improvement of sanitation services. The figures just showing an example of what that phase out of unsafe sanitation practices system would look like. So you see that on the left would be starting off with unsafe practices that are mostly in green in brown and red. And over time, those practices are being phased out. And it was essentially being eliminated. We're also phasing in the blue and green safe practices and making sure that over time, those are the ones that become prevalent. And just to emphasize that the safe practices are again a mix of different types of sanitation systems. Not sewer but with safe conveyance of the excreta and appropriate treatment, or it could be centralized and decentralized storage that has treatment. And again, like I mentioned, we could also use a disease based approach. And this is where it's really important to be working with the health sector, where we can say for instance, there are areas that we want to target for elimination of so transmitted health ailments and overlaying that with coverage of sanitation. And on the map that on the you see on the figure that the map on the left is showing areas that have low sanitation coverage and high prevalence of so transmitted health and on the right. It's showing low sanitation coverage and high prevalence of schistosomiasis. And those places that I read those high priority areas where those sanitation improvements could be prioritized. All of these things need to be embedded in a robust regulatory framework in order to make sure that the services that we're delivering are actually safe, that there's some oversight to ensure that services are being delivered in the manner that they should be, and that we're actually reaching our targets and regulation is really important for that. But there are some key principles that we want to keep in mind when we are regulating sanitation services. And one of those is that we need to be interpreting interpreting what sanitary sanitation means at each step of the service chain, and therefore what that might mean for regulation. So in other words, there is no one size fits all regulation that can be applied across the entire service chain, we really need to be looking at each step and think about thinking about what regulatory mechanisms can be applied. We also need to be recognizing different types of sanitation systems, so both sword and non sword and making sure that there's inclusively in those systems. We need to be thinking about service quality in terms of how are the sanitation services are being delivered and how that relates to public health so applying a public health based risk assessment and management approach to the delivery of those services. Like I mentioned, the importance of being technology agnostic, not just in the delivery of the services but also in the regulation of those services. So not being too prescriptive about what technologies can be applied when delivering sanitation services and what that means for regulation. We also need to set out levels of performance criteria and allow flexibility and how they can be achieved recognizing that different communities might be varying levels of development, and really allowing for that incremental process, but ensuring that say services are still safe. And of course we need to have the supporting legislation and violence, both at the national level level to make sure that all this works. So what does this mean in practice. Essentially, there are three questions that we want to answer when we're talking about the regulation that support embedding of safely managed system, they can manage sanitation in our national systems. And those questions are where, what, and whom. So we've already touched a little bit on the where so how where can safely managed sanitation be reflected at the national and local level and in our regulatory systems. So again, there's no one size fits all we go back to a sanitation service chain and look across the whole chain to think about okay what is already in existence are they already regulatory frameworks and mechanisms that are in existence. What extent are they influential and what extent are they helping us to meet our sanitation related targets and also public health related targets with that the next question that we want to be asking is what so specifically what kind of regulations are going to be implemented. And because sanitation and campuses, a range of sectors, it's not just environment or just water there's also to do with urban and town planning, building regulations etc. We also want to be thinking about what regulatory tools are we appropriate. So if we think about toilets, for instance, we want to think about construction codes for the installation of those toilets. When we think about conveyance, we want to be thinking about the safety of the sanitation workers who are going to be conveying the excreta for instance, do as pit emptying services or desledging. Do those sanitation workers have appropriate personal appropriate protective equipment, are they vaccinated, are they actually carrying out their job in a safe manner. When we think about treatment, it could be a public utility wastewater treatment plant and what are the regulatory requirements that they are required to fulfill, or if they are private entities is there a licensing code that's in place. And then we also want to think about the end use or disposal of that excreta are the treatment standards that are in place that should be met as prior to disposal of that waste or the end use either for in agriculture or something. And then the third question that we want to ask ourselves is the who and I think this is a very thorny question in this sector, not just in terms of who is delivering services but who's actually responsible for regulating those services. Because there are multiple actors that are involved there are multiple sectors, what is really important is mapping, who is doing what, but also having alignment and making sure that where their gaps, where there's discrepancy that is addressed from the onset so that there's coherence across all the actors that are involved and across all the regulatory authorities. And then also when it comes to the service delivery, the other question that we're asking is who's responsible, not just for regulating but who is responsible for delivering those services and how are they regulated. So they're the individual services where for instance that the plumber might be coming in to install your toilet, but then they are shared services such as the installation of the service network in town X. Those are very different entities, and the way they're being regulated is also different so understanding what gaps exist and making sure that there is alignment is very important. I think I'll stop here for now, but just to flag that this question of who is a person that we're trying to tackle. As WHL is actually working on a roadmap to help regulators advance from having little or no regulation of sanitation to a functional regulatory system. And so we look forward to sharing with you from that or equally hearing from you on your experiences. And with that, I will hand it back to Yvonne. Thank you. Thank you very much, Betsy. And so we've heard the four key recommendations of the WHL guidelines and we've also heard how to embed safely managed sanitation national assistance for so back to the quiz. And we see who has been paying attention. So that's true or false statements. Again, you have to scroll down to see the questions. On the first question, full community coverage of at least basic sanitation is needed to protect health. Choose true or false. The next statement implementation should first focus on increasing demand for toilets, and then address supply. Third question, when choosing what sanitation system to use, planners should remain technology agnostic so long as the solution meets minimum standards. The fourth question, work on the lower risks first, as these are often cheaper and easier to implement. Is it true or false? The next statement says countries need to set ambitious but realistic targets for sanitation based on a robust analysis of the current situation and the potential for accelerated progress in sanitation by 2030. The next question is that the sanitation service chain that is toilets, conveyance treatment and so forth is best served by a single dedicated regulatory mechanism. True or false. So, I think within the next 10, 15 seconds. So just a question of reading the statement and picking whether it is true or false. And then we see what's the results are looking like this time. And also in the meantime, thanks to Grace Kihumba who was very attentive and realized that the answers in the previous quiz, most people had actually gotten them correct, and which is good. So, to answer the answers, let's see what it looks like. So the first question, which is about safe toilets, full capacity coverage or at least basic sanitation is true. The lower level of coverage benefits households with privacy and convenience gain are typically not detected until at least 70% coverage is achieved. So most participants got that right, well done. So the second question implementation should first focus on increasing demand for toilets, which is related, which is false. Well done to the 56% but answered. When choosing a sanitation system to use. It is true. If you should remain techno technology agnostic well done. The next question, the correct answer is work on the low risk. The correct answer is that it is false. So, again, well done to the majority 62% got that correct from those that answered question five, which is on what countries need to set realistic targets. The correct answer is that it is true and really the majority got that correct excellent. And on the last question, the correct answer is that it is false SMS at any step of the chain may require combination of codes technical standards licensing or utility regulation not just a single dedicated regulatory mechanism. So well done for the correct answers and we move on to the next presentation, which is looking at risk based tools to implement safely managed sanitation and sanitation safety planning. Leonella over to you. Thank you. Thank you very much, you want. I would like to introduce one of the double show recommended with assessment and management tools, which is called sanitation safety planning with this tool, what we can do is an in depth assessment and prepare a management and investment plan. The SSP is different from the SFD or excreta flow diagrams, but is used for a rapid assessment with advocacy purposes. And also it is different from the sanitary inspection forms that are used to conduct a simplified assessment of on site facilities. The SSP is a step by step approach for local risk assessment and management along the entire sanitation service change that results in the identification of the highest health risk to plan improvements. The way how SSP work is very simple. First we prepare for the process, then we describe the sanitation system. Next we identify hazards and hazardous events and conduct the health risk based assessment. The resulting information we use to take decisions about what improvements are needed. Then we define the monitoring mechanisms. And finally we develop supporting programs and review plan to illustrate how SSP works. Let's watch the following video. Sanitation safety planning or SSP for short is a risk based management tool for sanitation systems. A safely managed sanitation system prevents exposure to disease causing excreta at all steps of the sanitation chain, from containment through emptying, transport, treatment and to disposal or reuse. It can be used together with excreta flow diagrams or SFDs shown in the previous module to make sure that excreta reaches safe rather than unsafe endpoints. SSP reduces health impacts while increasing the benefits of reuse. SSP can be used for all kinds of sanitation systems, both in formal and informal settings. The approach is best used for improving existing systems. In communities with no sanitation, demand creation should be prioritised. So how do SSPs work? First we need to understand the system we plan to manage. This is referred to as a system assessment phase where the sanitation chain and exposure groups and pathways are identified and expressed as hazards. Risks are recessed and when they are unacceptable improvements are designed to reduce them. This approach ensures action is prioritised according to risk. Monitoring and management using multiple barriers along the chain ensure that the whole system is operating as intended. SSP can be applied in many settings. Today I'll be illustrating the approach in an informal urban setting typical of growing cities in many countries. We'll follow the chain showing examples of exposure groups, hazards, controls and monitoring at each step to build up a safely managed sanitation system that protects public health. Notice as we go that not all improvements involve expensive capital investment. Changes in management and behaviour can also significantly reduce risks. Also notice that different stakeholders bear responsibility for controls and monitoring at each step. Here is a simple pit latrine with manual emptying. Although excreta are contained in the latrine, this unimproved system poses a number of health risks. Exposure groups include the users, the workers who empty the containers and the surrounding community. Children and the elderly are especially vulnerable from contact with soiled surfaces in an unhygienic latrine. These groups may be exposed via direct excreta contact through the feet and hands and when excreta is inadvertently transferred to the mouth via dirty hands or flies. The risks here are medium to high depending on the exposure group. While the goal is a more hygienic, improved sanitation technology, we can still reduce risks. For example, controls such as wearing shoes, better cleaning of the latrine, personal protective equipment for workers and using an emptying system that reduces direct contact will all incrementally improve the system. Visual monitoring of these measures by a community health worker is a simple way to check and respond if these controls are not in place. This latrine with septic tank is an improved technology that poses less risk to users than the previous situation. Let's look at the emptying process. Motorized emptying and transport is much safer than manual emptying, but there are still risks that need to be managed. A key exposure group is the workers. Hazardous vents are mostly related to blockages and malfunction of the equipment. For example, the operators may be sprayed with sludge and also contaminate the surrounding area. These risks are typically high. Here are some controls to protect workers. Providing appropriate equipment, working according to standard operating procedures, and ensuring workers with personal protective equipment. The organization responsible for overseeing collection and transport can set minimum standards like these and make spot checks to monitor if they are followed. In this example, all of the fecal sludge is delivered to the treatment plant. But in poorly managed systems, some may be diverted to dumping sites. This can have serious health and environmental impacts. SSP should also identify dumping as a hazardous event and include controls and monitoring to manage these risks posed to the wider community. At the treatment step, it is vital that the treatment process operates well so that effluent and biosolids meet agreed standards. If not, users on farms and consumers of the farm produce will be exposed to an unacceptable risk. The hazardous events may include overloading of the plant, breakdowns, the processing temperature and time, and the presence of flies or mosquitoes, or seasonal factors such as high rainfall that may affect performance. The risks and consequences of these are high. Example controls include proper design and construction, trained operators, and a preventive maintenance program. Monitoring may include periodic testing of effluent and checks on delivery volumes. But even the best treatment processes will occasionally not meet standards. In some cases, lower levels of treatment may be unavoidable with the existing technology or desired by farmers who wish to access nutrients for reuse. That's why barriers at the next reuse step are particularly important. During reuse, there are risks to farmers using the biosolids, especially where intestinal worm infections are prevalent. Risks will depend on the performance of the treatment plant in the previous step and the way the biosolids are applied in the farm, for example manual or mechanical application. When produce is sold to the general population for consumption, many people are potentially at risk. Pathogens can be recycled back to the community at large and lead to a disease outbreak. This is costly in terms of public health but can also ruin the reputation and operation of businesses that reuse wastewater and sludge. The type of crop grown and the application method affects the risk for consumers. For example, crops eaten raw have a much higher risk compared with crops which are cooked or processed before eating. These risks are potentially high. Controls that can be used include selection of crops not eaten raw, setting a time between the last application and harvesting to allow pathogens to die off naturally, and washing of produce and clean water before sale. Monitoring may include checking crop types, application and harvesting practice, as well as hygiene during the packing and sale. We have just followed the modules in the SSP manual. First describing the sanitation system, identifying hazardous events and exposure risks, developing and implementing improvement plans, monitoring controls and verifying performance. Coordination amongst stakeholders is needed to implement all controls in monitoring in a safely managed system. That's why establishing a team at the outset with members representing each step of the chain is vital to prepare for SSP. Coordination can be challenging, but evidence shows that safely managed systems lead to far higher health gains than improved sanitation alone. Further, using the multiple barrier approach reduces dependence on capital intensive treatment technologies as the main barrier. Controls can be included at any step and incrementally improved over time as resources permit. In summary, SSP is a risk-based tool for safely managing existing sanitation systems. SSP coordinates improvements in monitoring by actors along the sanitation chain. SSP does not rely on treatment only. It uses multiple barriers including behaviors, management and technology to prevent exposure. The SSP manual that includes more guidance and tips is available in several languages on the WHO website, along with other resources to help users get started and implement SSP. So we invite you to visit the doublet shows Learning Hop which you find in ssp-learninghop.creation.camp. There you will see that you will be able to find an online training which has different videos and resources to learn about each of these steps and also implement them. Also, there is a training package that is designed specifically for SSP trainers with a training guide, power points and materials ready to be used. And finally, there is also a library that contains all supporting documents. Thank you very much. Thank you. Following from the presentation of Leonela, I just wanted to quickly talk about sanitary inspections. I'm trying to advance to the next slide. Thank you. Another form of risk assessment and management is sanitary inspection and that consists of a simple observation, standardized observation checklist, which can be used to assess risks and also identify corrective actions. For the sanitation inspections, they really look at the parts of the sanitation chain that can be observed at the household level. So that only covers the toilet and containment as well as on-site treatment step of the chain. So just important to note that other tools are needed to assess conveyance and treatment and disposal or reuse of site. So the sanitation inspection form are part of the package and one of the element of the package is a set of sanitation system fact sheets, which includes a lot more details on applicability of different sanitation system contexts as well as some design consideration. Sorry, so this is part of a, I'll try to keep it quick because I know we're running out of time. So the sanitation system fact sheets are part of a set of tools that includes a fact sheet that gives detail on applicability, design consideration, operation and maintenance, as well as measures to protect, protect public health for 11 commodity sanitation systems. And you can see here an example of the list of the sanitation inspection forms with the list of observations. The form is available in PDF format as well as online on the platform, online platform, which is hosted by M. Walter. Please. So there's multiple benefits of using sanitary inspection forms. They are user friendly. They can be used by non-specialists. They're easy and quick way of identifying hazards. They suitable when there's limited amount of time and resources, they can be easily adapted to different contexts, and they can be aggregated to support safely managed sanitation in situ. Of course, there's a number of limitations, there's a limited number of questions. The risks that are below ground and inside the containment are not easily observed. Another issue that they assume every risk has an equal value and we know that it's not always true. And it also requires adaptation to local context. And as I said, they're available in PDF and online. So one of the common challenge that a space is how to sustain open defecation free status and how to move up the ladder to safely manage sanitation services. So sanitary inspection form can really be used by local governments that in order to support programs to prevent backsliding to open defecation to make some upgrades of unimproved toilets to at least basic toilets. And whenever it's possible to achieve safely managed sanitation on site or we speak or search anything in treatment. And to monitor status and aggregate data to national level for regulation purposes as well as for SDG 6.2 monitoring. Next slide please. And look at an example of the use of the use of sanitary inspection in Ireland. And you will see a few slides from the Irish EPA. And you will have a short quiz if we're able to have time but I just wanted to highlight a few features that you will have to look at during the presentation. The first one is the risk based approach to the selection of household for inspection that they use small but nationally representative sample for conducting inspections. They are linked to follow up improvement by households and municipalities. Throughout this initiative, they deploy information incentives and enforcement mechanism to support system upgrades. And it also enable to strengthen national and local data governance and accountability to national and regional regulators. Next slide please. Here we will learn about the regulation of domestic wastewater treatment systems in Ireland and see background information on the regulatory system. There are four main areas. The first relates to planning control regulations and standards that are required for the construction and installation of domestic wastewater treatment systems in Ireland. The second relates to the registration and inspection of these systems under the national inspection plan. Inspections are completed nationally but prioritized in highest risk areas. The third area relates to the grant schemes that are available to fix systems that fail inspection. And lastly, the local authorities may deal with some complaints regarding septic tanks and they may carry out inspections following the receipt of a complaint. This is a list of the main legislation relating to septic tanks. The Water Service Amendment Act was brought into law in 2012. The domestic wastewater treatment system regulations which govern the operation and maintenance of domestic wastewater treatment systems and the requirements for desludging were also brought into law in 2012. At the bottom of the list are the housing financial assistance regulations that brought the septic tank grant schemes into law to help householders fix systems that fail inspections and in other areas. Inspection responsibilities are provided for under the Water Service Amendment Act that was brought into law in 2012. Homeowners had to register existing systems by the 1st of February 2013. The homeowner is required to comply with regulations and they must ensure that the system is not a risk to human health or the environment. The homeowners can't refuse, obstruct and peed mislead or fail to comply with an inspection. The Water Service's authorities are the local councils and they must take and maintain registrations and this is done through the protectorwater.ie website. The Water Service's authority inspectors conduct the inspections of the domestic wastewater treatment systems and they enforce the findings and issue advisory notices on the inspections. The EPA's responsibility is to appoint inspectors, issue the National Inspection Plan and supervise the Water Service's authorities work in this area. Some of the key requirements of regulations are shown in red on this slide. Domestic wastewater treatment systems should not leak. Roof water or surface water should not be allowed to enter the system. All parts of the system should be fit for purpose. Systems should be dislodged at appropriate intervals by an authorized contractor. The EPA provides a simple reference table on its website to help homeowners establish what an appropriate interval would be for their system. Homeowners need to keep receipts of dislodging. Overall, homeowners should ensure that their system is not a risk to human health or the environment. The National Inspection Plan began in 2013. The next plan covered the period 2015 to 2017, then 2018 to 2021 and the latest plan covers 2022 to 2026. Under the most recent plan, water services authorities are required to complete a minimum of 1,000 inspections nationally per annum. This increases to 1,200 from 2023. They may complete additional inspections where evidence exists that domestic wastewater treatment systems are causing an issue in a particular catchment. The 1,000 or 1,200 inspections are prioritized into areas of highest relative risk. These are close to rivers and areas with shallow soils and drinking water wells. The number of inspections are allocated to water services authorities, pro rata, based on the proportion of houses in those risk areas in the water services authority area. Specific site selection is done annually by the water services authorities using a map and tables which show the various risk zones and the number of inspections to be completed in each risk zone as set out in the National Inspection Plan. Inspectors in the water services authorities attend a training course. There are approximately 100 inspectors nationally. Inspectors would expect the following from a good system. No rainwater, clean surface water entering the system, no leaks, no ponding, no unauthorized discharges, components in working order, proper maintenance and operation being completed. The system is dislodged and the system is not a risk to human health and the environment. If a system fails and remediation is required, the water services authority issues an advisory notice to the homeowner, which outlines the measures required to fix the system and the timelines for completion of remediation works. If any structural remediation works need to be completed, there are planning exemptions under the planning and development regulations to allow homeowners to improve a system without requiring planning. Also, variances to the code of practice requirements may be considered by the local authority. There are grants available to help homeowners fix systems that fail in an inspection, so this allows them to fix their systems more readily. So, just to give you a flavor of the latest report, the Domestic Wastewater Treatment System Inspections Report was published in June 2022 and reported on the inspections completed in 2021. There were 1,147 inspections completed in 2021 and these found that 53% of systems that were inspected failed inspection. Overall, in the period from when the National Inspection Plan began in 2013 to the end of 2021, 75% of systems that failed have been fixed, so that leaves a quarter of them that still need to be fixed. In some of these, legal cases have been initiated. In total, 36 legal actions have been initiated by seven water services authorities nationally. The figure shows the reasons for failure. It should be noted here that individual systems can fail for multiple reasons. You will see that the leading issue found is that homeowners do not dislodge and maintain their tanks. The pictures were taken by inspectors in the field and they show a discharge to a surface water drain and effluent ponding around a septic tank. The final slide outlines some of the engagement work that is carried out in this area. This is done to provide information to the public about inspections, the risk of their systems not working properly and how they can fix their systems. Several information leaflets have been published to help with public engagement, which are used by water services authorities to inform the public in their area. The EPA also publishes a simple infographic to inform the public of the findings of the latest inspections report. It gives a very high level flavor of what the inspections are finding and where homeowners can find assistance to enable them to fix their systems. So thanks, we hope that this presentation gave you some insights into some of the uses and benefits of the signature inspection now hand over to you for the quiz. Thank you very much Sophie and thank you for to learn as well for the two presentations. The quizzes, the third quiz very quickly, we'll have just one minute for this quiz. There are four questions in this quiz. And you pick the correct answer. The first one which type of risk assessment approach is best used for in depth assessment and management planning. Second, how were households selected for inspection. The third question is what kind of measures were used to get households to fix failing systems. And how is the data reported and used. So, I will also be requesting our two panelists to get ready. As we move from the quiz to a panel discussion will have exactly five minutes for each panelist to be able to give us practical perspective of the issues that have been presented today. So, we'll close the quiz and look at what the answers are. We've had a chance to answer. So the first question, the correct answer is the excellent those who managed to answer sanitation safety planning is the answer there. Household selected for inspection question to the correct answer is C. So again, well done to those who managed to answer it got it correct. And three, what kind of measures were used to get households to fix failing systems. The correct answer is actually D all of the above, and most participants got that right as well. So the last question in the poll is how is the data reported and used the correct answer is again D for all the purposes indicated there. Thank you very much for having participated in the quiz will now move to our two panelist panelists Charlotte is from Ghana, and Dr Vijay is from India. Charlotte, if you can just switch on your video. Thank you. Charlotte has spent the last two decades working at the local regional and national levels in Ghana's water sanitation sector and also in several donor funded projects. Based on your experience, Charlotte, how can the key recommendations the four key recommendations are given off the WHO guidelines on sanitation and health be addressed at these levels over to you. Thank you very much. Certainly, achieving safely money sanitation for countries is a big deal, especially in Africa. In Ghana, for instance, if you look at our coverage now, we have only 59.3% of the household only toilets, then 23% using public facilities and 17.7% using open edification. So if you look at the four recommendations that's presented by the WHO, safe sanitation. For instance, in Ghana, we have the urban sanitation strategy. We have most of the urban settlements, partisan open edification so with this strategy, we are promoting improved sanitation at a household level. And when you go to the implementation side of this, there are a lot of challenges that you have to deal with. You have availability of space being a challenge, affordability of certain class of the people. We are looking at even technology for some of your communities, technical assistance from the local governance structure, and even the quality of service delivery that is provided. We have the whole value chain. You need to come up with innovative solutions. And we focus on behavioral change and communication strategies to be able to educate the populace to understand the importance of improved sanitation and then safe water. With the various interventions, we get a lot of demand for the facility. And then on the step of supply, you realize that you don't even have the sanitation businesses to even meet the demand of the people. So you need to build your supply space, bringing in citizens to train for main cooperative for private sector to be able to secure guarantee funds and all that. And of course, the safety of your empty carrier, the treatment in Ghana, we don't have a relative body that manage the sanitation services. So most of the emptying the treatment are done by private sector, but they are licensed by the local government. So you need to support them with training and we have social and environmental safe gas frameworks, where we are able to train them on operational health and safety, being able to support them with PPEs and all that to protect them as well. But if you look at the chain itself, you need a very strong coordinated platform for all stakeholders to play their role. For instance, the Ghana we learned in the beta way in 2015, where our water quality was compromised during the flooding. So the health surveillance system gave us the alert of cases of car and we reported several cases of foreign by the time we were like the whole country, there was an outbreak. So the surveillance system help us to put national technical working group for wash. And we have members from NGO, civil society, government, education, health and this platform, they all coordinate the plan so we come up with plan. We look for funding and then we do the dissemination, but of course you need to bring in your social norms tools to be able to catch up with others to your religion, the faith based organizations, the traditional leaders and all that, but government investment on the treatment is very critical. Investing in the infrastructure for treatment is expensive. But when you go down to the local level, you're able to bring in some innovations in technology, you look for simplified systems. You look at condominium systems be worse and all that you are able to break the barrier of contamination at that small scale, but on the larger scale we are looking at thicker slag management systems for our cities for the secondary cities, even the population that's 5,000, you should be able to have a system that will be able to serve them to break the transordinary recommendations are very good. If you implement it, you'll be able to at least reduce your spread of diseases or contamination and your public health will be improved. Thank you very much. Thank you so much Charlotte and very valid points that you've raised their very pertinence to achieving safely minus sanitation. We move to Dr. Vijay. You yourself have also been involved in policy and program formulation in the ministry for public health engineering sector, which included also clean intermission. So how has implementing transformative wash where we're talking about reducing risks at all steps of the chain to achieve the health impact. How has that led to India's open defecation free status over to you. Thank you. My greetings to all audiences. I think safely managed sanitation is very well explained and we have come across that at various levels, what are precautions to be taken and what to be done as far as India journey for this open defecation is concerned. This was launched in 2014 at that time open defecation was even prevalent cleanliness and the general awareness, not to that level that is expected. So after launch of this mission, we adopted a strategy that in mission mode, we were incentivizing also, we were making it as a public movement also. And apart from that, along with implementation and financial support, we took this step that how to encourage people like competitive spirit, we brought through a, let us say, competition that we call clean survey of cities. That is the largest, I will say survey we call social services in the world in the urban area, if you say around, around 400 million participants, we are participating in that. So that was bringing a lot of competition between the cities and they were trying to meet various requirements that how they become open defecation free, even cleanliness and other things also they bring. So, in that case apart from that we launched further this open defecation certification. In first stage it started that people should have their own toilets and nobody should go for open defecation. That give a very marvelous success because they all consulted efforts, but we didn't stop to that. We went to next level where the proper contentment was also targeted through ODF plus that is a variant of higher level. And then we went for comments and then proper treatment that comes frequent treatment at ODF plus plus and then lastly we took a the highest level water plus where it was a sustainable sanitation like apart from proper treatment it is being decidedly huge. Exactly if you see this vast change that transformative vast change that it is the risk at all the steps, these are the steps we have covered. Maybe I am not very much exposed to these definitions earlier I will say, but fortunately these are definitions we were following. And when we acquainted that what is the JMP and what is safely managed sanitation. In that case we find that what is the requirement exactly on the same line we are moving. And we are targeting because after this clean India mission we are we are extending a second version where we are funding for this water sanitation portion also so that not only not only contentment but proper treatment is also taken. Apart from lastly I would like to mention that this SFD seat flow diagram also we bring in our advisory and these guidelines that also help people to plan and identify that and the welfare of this imply working in sanitation sector. They were also taken and that was taken that maximum it should be done in a mechanized mode, not manual at any cost. And for that a legislation was also brought. These are things that brought to such a level that we are aspiring that we will be able to achieve this whole transformative vast change that is there up to end huge and we are, we are heading towards this sustainable sanitation and also sustainability and sustainability in our system. So, this is how I wanted to say thank you very much. Thank you very much Dr vision very practical experience there and some some good issues for people to be able to draw in particularly related to issues of definitions and the implication for the sector and what is counted as safely managed sanitation. There are a lot of questions in the Q&A, unfortunately due to time limitations when able to to take them all for for response. However, there are resources that are related to this learning package that WTO has presented. And we are very grateful for everybody's inputs. And I'll just request Kate just to talk about how people can be supported a number of things that are coming up in the Q&A some suggestions also that people are putting across. Kate, how can participants gain more insight and how can they be supported. Yes, so there's a huge range of resources here which we've just gone over lightly. We're keen to hear from any of you who would like to go into more detail on these topics we do provide country or region based training but most specifically what's coming next is the poll where we can offer more in depth sessions via webinar on the things that you find most interesting here. So we'd really like to hear from you what you'd like to learn more about via IWA webinars and so please have a look at the poll here and we'll take those into account and work with the IWA team to develop more in depth material in response to your request. So go ahead and we'll close the poll in maybe 30 seconds. And I think that is, that's us for the day. So thank you so much Kate and I want to say thank you to the IWA team for having co-hosted this webinar. On the WHO introducing the new WHO learning package for safely managed sanitation. So there are other learning opportunities also coming up under IWA. There's the regional call for connecting young water professionals in the Americas. There's also a weapon on embracing indigenous perspectives to achieve sustainable development goals but do not forget also that there is an answer with Sanitation in October in Johannesburg. Please look it up. And also the IWA Development Congress that is coming up in Kigali in December. So please register, participate and keep interacting on these issues so that we're able to make a positive impact on the sector. IWA is also calling you to become a member of the network if you're not yet a member. So thank you to everyone and have a good day, good evening and we'll see you next time.