Facilitating behaviour change for the adoption of ‘non-treatment’ options for the implementation of the 2006 WHO wastewate...
Content<br />Risk situation & options to mitigate risk<br />Cost-effectiveness of these mitigation options<br />Ways to su...
        Wastewater Irrigated Area<br />  China*<br />Mexico<br />India<br />China: est. 4 million ha; out of proportion<br...
 Food for 10% of global population</li></ul>Main driver: Water Scarcity<br />Source: Jiménez and Asano, 2008; Scott et al....
2006 Guidelines<br />Source: www.who.int/en/<br />
Wastewater generation<br />Farmer/ Producer<br />Traders/Retailers<br />Street food kitchens<br />Consumer<br />Safe Irrig...
Wastewater and faecal sludge treatment plants in Ghana<br />Source: Murray & Drechsel, 2011<br />
Wastewater and faecal sludge treatment plants in Ghanatreat in urban areas < 10% of ww<br />How many of them work ?<br />1...
Photo Credit: IWMI<br />
Photo Credit: IWMI<br />
Are at risk every day in Ghana’s 5 biggest cities:<br />2,500- 3,000farmers and traders of exotic vegetables<br />20,000-2...
Wastewater generation<br />Farmer/ Producer<br />Traders/Retailers<br />Street food kitchens<br />Consumer<br />Safe Irrig...
PHILIP AMOAH<br />
Low-cost interventions at one or more entry points could avert up to 90% of DALYs*<br />DALYs: Disability Adjusted Life Ye...
video.google.com<br />Source: IWMI, WHO<br />
How much would it cost to avert the DALYs? <br />Costing the promotion & implementation of interventions<br />Costs to far...
Cost-effectiveness of interventions(Price of gaining 1 healthy life year)<br />Adoption rate		 US$/DALY* averted<br />On-f...
Hazard comparison for Accra, Ghana, via different exposure pathways<br />Workers exposed at WWTPs<br />Faecal sludge dispo...
Success of<br />treatment options depend on appropriate technologies, and incentives  supporting responsive maintenance sy...
Why should farmers/traders/consumers change their behavior?<br />Existing risk awareness/social responsibility/self-protec...
What could trigger behavior change?<br />1. Consumers<br />Visual neatness of food, trust in trader, and (low) price. Risk...
2. Farmers<br />Significant financial motivation to remain in business (high cash crop income; market proximity)<br />High...
 Positive image, safety awards (<-> media pressure)</li></ul> Financial incentives: Market-access, credit<br />
3. Food vendors (street restaurants)<br /><ul><li>Higher awareness of microbial risk than farmers
High willingness to avoid complaining customers
 Customer satisfaction
 Prestige (certification, awards)  good for business</li></li></ul><li>Adoption stages<br />Behavior change supporting co...
Whom would you listen to?<br />Food Vendors<br />Farmers<br />Source: IWMI, unpub.<br />
Visualizing messages<br />		     Imported vs. local symbols<br />Source: www.fightbac.org					<br />
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Facilitating behaviour change for the adoption of non treatment options for the implementation of the 2006 who wastewater use guidelines

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Facilitating behaviour change for the adoption of 'non-treatment' options for the implementation of the 2006 WHO wastewater use guidelines

Pay Drechsel, Hanna Karg and Eline Boelee

Presented at the IWA session "Hygienic Risks of Sanitation Systems" at the networking weekend of "Water and Health: Where Science Meets Policy"
The University of North Carolina at Chapel Hill, USA.
October 23-24, 2010

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Facilitating behaviour change for the adoption of non treatment options for the implementation of the 2006 who wastewater use guidelines

  1. 1. Facilitating behaviour change for the adoption of ‘non-treatment’ options for the implementation of the 2006 WHO wastewater use guidelines<br />Pay Drechsel, Hanna Karg and Eline Boelee<br />Presented at the IWA session “Hygienic Risks of Sanitation Systems” at the networking weekend of “Water and Health: Where Science Meets Policy,”<br />The University of North Carolina at Chapel Hill, USA.<br />October 23-24, 2010<br />
  2. 2. Content<br />Risk situation & options to mitigate risk<br />Cost-effectiveness of these mitigation options<br />Ways to support their adoption on farm and in street food restaurants<br />Example:<br />Ghana<br />
  3. 3. Wastewater Irrigated Area<br /> China*<br />Mexico<br />India<br />China: est. 4 million ha; out of proportion<br />Chile#*<br />Syria*<br />Pakistan<br />Untreated wastewater <br />Colombia<br />Argentina<br />SA*<br />Ghana*<br />Vietnam<br />Peru<br />Turkey<br />Morocco<br />Egypt#<br />Kuwait*<br />Sudan<br />Tunisia<br />Nepal#<br />Bolivia*<br />Chile<br />Mexico<br />Israel#<br />Egypt*<br /> Treated wastewater<br />Cyprus<br />Italy*<br />Argentina<br />Australia<br />UAE#<br />USA<br />Jordan<br />Turkey*<br />Syria*<br />Tunisia<br />Kuwait#<br />Oman#<br />France<br />Libya#<br />S.Arabia<br />Germany<br />0<br />10<br />20<br />30<br />40<br />50<br />60<br />70<br />80<br />90<br />100<br />110<br />120<br />130<br />140<br />150<br />160<br />170<br />180<br />190<br />200<br />Area ( '000 ha)<br />Main driver: Water Pollution<br /><ul><li>10% of global irrigated area
  4. 4. Food for 10% of global population</li></ul>Main driver: Water Scarcity<br />Source: Jiménez and Asano, 2008; Scott et al., 2010.<br />
  5. 5. 2006 Guidelines<br />Source: www.who.int/en/<br />
  6. 6. Wastewater generation<br />Farmer/ Producer<br />Traders/Retailers<br />Street food kitchens<br />Consumer<br />Safe IrrigationPractices<br />HygienicHandlingPractices<br />Safe food washing and preparation <br />Wastewater treatment<br />Awareness creation to create demand for safe produce<br />Facilitating behaviour change via education, financial & non-financial incentives, and <br />regular inspections<br />Multi-barrier approach<br /> low-income countries<br />Source: Ilic, S.; Drechsel, P.; Amoah, P.; LeJeune, J. 2010<br />
  7. 7. Wastewater and faecal sludge treatment plants in Ghana<br />Source: Murray & Drechsel, 2011<br />
  8. 8. Wastewater and faecal sludge treatment plants in Ghanatreat in urban areas < 10% of ww<br />How many of them work ?<br />13% operating +/- as designed <br />30% have some rest capacity <br />57% (un)officially broken down<br />Source: Murray & Drechsel, 2011<br />
  9. 9. Photo Credit: IWMI<br />
  10. 10. Photo Credit: IWMI<br />
  11. 11. Are at risk every day in Ghana’s 5 biggest cities:<br />2,500- 3,000farmers and traders of exotic vegetables<br />20,000-26,000 staff ofstreet foodrestaurants,<br />610,000- 860,000 street food consumers<br /> ca. 12,000 lost DALYs* annually (without family members)<br />*DALYs: Disability Adjusted Life Years<br />Source: IWMI, 2009<br />
  12. 12. Wastewater generation<br />Farmer/ Producer<br />Traders/Retailers<br />Street food kitchens<br />Consumer<br />Safe IrrigationPractices<br />HygienicHandlingPractices<br />Safe food washing and preparation <br />Wastewater treatment<br />Awareness creation to create demand for safe produce<br />Facilitating behaviour change via education, financial & non-financial incentives, and <br />regular inspections<br />Applied, participatory action research<br />Source: Ilic, S.; Drechsel, P.; Amoah, P.; LeJeune, J. 2010<br />
  13. 13. PHILIP AMOAH<br />
  14. 14. Low-cost interventions at one or more entry points could avert up to 90% of DALYs*<br />DALYs: Disability Adjusted Life Years Source: Amoah et.al. 2011, forthcoming publication<br />
  15. 15. video.google.com<br />Source: IWMI, WHO<br />
  16. 16. How much would it cost to avert the DALYs? <br />Costing the promotion & implementation of interventions<br />Costs to farmers (e.g. to buy and repair a drip kit)<br />Cost to kitchen staff (e.g. to buy chlorine tablets)<br />Costs to society (e.g. to train and monitor farmers)<br />QMRA* with and without different interventions<br />Cost-effectiveness analysis (US$ per DALY* averted)<br />*QMRA: Quantitative Microbial Risk Assessment <br />*DALYs: Disability Adjusted Life Years<br />
  17. 17. Cost-effectiveness of interventions(Price of gaining 1 healthy life year)<br />Adoption rate US$/DALY* averted<br />On-farm Off-farm<br /> 75% + 75% $ 87<br />75% + 25% $ 94<br /> 25% + 75% $ 95<br /> 25% + 25% $ 394<br /> One new small WWTP*/city ca. $ 4000 (5 cities)<br />*DALYs: Disability Adjusted Life Years <br />*WWTP: Waste Water Treatment Plant Source: Seidu and Drechsel, 2010<br />
  18. 18. Hazard comparison for Accra, Ghana, via different exposure pathways<br />Workers exposed at WWTPs<br />Faecal sludge disposal exposure<br />Flooding of main river passing city<br />Failure of WWTP<br />Contaminated drinking water pipes<br />Swimming at Accra's beaches<br /> 94 $/DALY<br />Wastewater irrigated vegetables<br />>500 $/DALY<br />Children exposed to open drains<br />*DALYs: Disability Adjusted Life Years , *WWTP: Waste Water Treatment Plant Sources: Labite et al., 2010; IWMI, 2009<br />
  19. 19. Success of<br />treatment options depend on appropriate technologies, and incentives supporting responsive maintenance systems<br />non-treatment options depend on incentives for individual behavior change (lasting adoption)<br />
  20. 20. Why should farmers/traders/consumers change their behavior?<br />Existing risk awareness/social responsibility/self-protection<br />Investments in education & awareness creation <br />Enforced regulations (control & punitive fees)<br />Market demand for safer crops supported by a higher consumer willingness-to-pay<br />Financial incentives (subsidies on farm inputs, credit access, payments for environmental services, …)<br />Non-financial trigger and incentives (prestige, fear, etc.)<br />
  21. 21. What could trigger behavior change?<br />1. Consumers<br />Visual neatness of food, trust in trader, and (low) price. Risk awareness is marginal + too many other risk factors!<br /> Disgust could be an effective trigger to change habits (Ghana’s hand-wash campaign)<br />
  22. 22. 2. Farmers<br />Significant financial motivation to remain in business (high cash crop income; market proximity)<br />High competition for plots near streams <br />No land tenure security (public land), farmers could be expelled at any time<br /><ul><li> Strong incentive: Tenure security in exchange for safer irrigation practices
  23. 23. Positive image, safety awards (<-> media pressure)</li></ul> Financial incentives: Market-access, credit<br />
  24. 24. 3. Food vendors (street restaurants)<br /><ul><li>Higher awareness of microbial risk than farmers
  25. 25. High willingness to avoid complaining customers
  26. 26. Customer satisfaction
  27. 27. Prestige (certification, awards)  good for business</li></li></ul><li>Adoption stages<br />Behavior change supporting components<br />Supporting components<br />Adoption stages<br />Awareness <br />creation&<br />Is <br />health <br />risk <br />training<br />No<br />Awareness<br />awareness given?<br />à<br />Workshops<br /> / <br /> Field schools /<br />Yes<br /> Roadshow <br />à<br />Options for risk <br />Social Marketing<br />Are effective methods <br /> reduction <br />No<br />known?<br />à<br /> Providing <br />à<br />Formative Research:<br /> training material<br />Yes<br />Identification of <br />-<br /> Barriers for <br />Association<br />Does the practice bring <br />behavior change<br />any benefit to life? <br />-<br /> Motivators (drivers, <br />(personally, business, <br />triggers, peers)<br />No<br />tangible, intangible)<br />Incentives<br />,<br /> e.g.<br />-<br /> Communication <br />channels & media<br />à<br />Awards and <br />à<br /> Defining message<br /> certificates <br />Yes<br />à<br />Identifying<br /> partners <br />à<br /> Good media <br />Enforcement <br />for effective promotion <br /> publicity <br /> (e.g. Public <br /> - <br /> private <br />à<br /> New marketing <br />à<br /> Inquiry about <br />Is it easy to integrate it <br /> partnerships)<br /> channels <br /> vegetable <br />No<br />Acquisition<br />in daily life?<br />à<br /> Loans, tenure <br /> handling in<br /> security, subsidies,<br /> inspection <br /> training, ... <br /> forms <br />Yes<br />à<br />Becoming more <br />à<br /> Controls <br /> competitive<br />à<br /> Punitive fees <br />à<br /> Closure<br />Can the practice be <br />No<br />Application<br />maintained? <br />Source: Figure 16.2,Karg et al. 2010<br />
  28. 28. Whom would you listen to?<br />Food Vendors<br />Farmers<br />Source: IWMI, unpub.<br />
  29. 29. Visualizing messages<br /> Imported vs. local symbols<br />Source: www.fightbac.org <br />
  30. 30. To make the invisible risksvisible<br />These two symbols were not understood by the target group, but tests with GlitterBug lotion were promising (www.glitterbug.com).<br />Source: clipart, office.microsoft.com<br />Source: www. pdclipart.org<br />
  31. 31. More research needed on<br /> Many opportunities to learn from the WASH sector! <br />Financial and social incentives valid in the local context <br />Social marketing to promote non-treatment options<br />Triggers for behavior change<br />Source: www.who.int/en<br />Source: www.wsscc.org<br />
  32. 32. Reference<br /> Wastewater Irrigation and HealthAssessing and Mitigating Risk in Low-income Countries<br /> Earthscan<br /> 2010 •  400 pages  <br />Free online:<br />www.idrc.ca/openebooks/475-8/ or www.iwmi.org/Publications/Books/index.aspx<br />
  33. 33. Other related publications<br />Labite, H.; Lunani. I.; van der Steen, P.; Vairavamoorthy, K.; Drechsel, P.; Lens, P. 2010. Quantitative microbial risk analysis to evaluate health effects of interventions in the urban water system of Accra, Ghana. Journal of Water and Health, 8(3):417-430. <br />Murray, A. and P. Drechsel. (in press). Positive deviance in the sanitation sector in Ghana: Why do some wastewater treatment facilities work when the majority fails? Waterlines Vol. 30<br />Amoah, P.; Keraita,B.; Akple.M; Drechsel,P.; Abaidoo, R.C.; Konradsen,F. 2011. Low cost options for health risk reduction where crops are irrigated with polluted water in West Africa. IWMI Research Report 141, Colombo (forthcoming) <br /> For more information, please visit www.iwmi.org<br />

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