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Challenge 3 safe water opt

  1. 1. Safe Water Optimization Tool for Humanitarian Response Syed Imran Ali Ph.D., Dahdaleh Institute for Global Health Research, York University Jean-Francois Fesselet, Public Health Department, MSF-OCA Matt Arnold, MSF-OCA/DIGHR Emergency Data Science: Taking Advantage of the Data Flood | December 4th, 2018
  2. 2. • Waterborne diseases  leading threats • Safe water is essential for public health Core Challenge
  3. 3. • Chlorination is the main method for water treatment  Cheap, easy to use, offers residual protection • Current guidance not based on any field evidence  Often fails to ensure water is safe Core Challenge
  4. 4. • Hep E, South Sudan, 2012-13 • CDC: 40-60% households with no detectable chlorine1 • U of Barcelona: faecal viruses in stored water2 • Post-distribution contamination  waterborne diseases in camps in Uganda, Malawi, Kenya, Sudan3-8 Field Experience (1) CDC. Final Report: Hepatitis E Outbreak Investigation: Results from the Knowledge, Attitudes and Practices (KAP) Survey, Environmental Investigation, and Seroprevalence Survey in Jamam and Yusuf Batil Camps, Upper Nile, South Sudan; Centers for Disease Control and Prevention: Atlanta, 2013. (2) Guerrero-Latorre, L.; Hundesa, A.; Girones, R. Transmission sources of waterborne viruses in South Sudan refugee camps. CLEAN - Soil, Air, Water 2016, 44, 1–6. (3) Steele, A.; Clarke, B.; Watkins, O. Impact of jerry can disinfection in a camp environment - experiences in an IDP camp in Northern Uganda. Journal of Water and Health 2008, 6 (4), 559–564. (4) Swerdlow, D. L.; Malenga, G.; Begkoyian, G.; Nyangulu, D.; Toole, M.; Waldman, R. J.; Puhr, D. N. D.; Tauxe, R. V. Epidemic cholera among refugees in Malawi, Africa: treatment and transmission. Epidemiology and Infection 1997, 118 (3), 207–214. (5) Roberts, L.; Chartier, Y.; Chartier, O.; Malenga, G.; Toole, M.; Rodka, H. Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial. Bulletin of the World Health Organization 2001, 79 (4), 280–287. (6) Mahamud, A. S.; Ahmed, J. A.; Nyoka, R.; Auko, E.; Kahi, V.; Nguhi, M.; Burton, J. W.; Muhindo, B. Z.; Breiman, R. F.; Eidex, R. B. Epidemic cholera in Kakuma Refugee Camp, Kenya, 2009 : the importance of sanitation and soap. Journal of Infection in Developing Countries 2012, 6 (3), 234–241. (7) Shultz, A.; Omollo, J. O.; Burke, H.; Qassim, M.; Ochieng, J. B.; Weinberg, M.; Feikin, D. R.; Breiman, R. F. Cholera Outbreak in Kenyan Refugee Camp: Risk Factors for Illness and Importance of Sanitation. American Journal of Tropical Medicine and Hygiene 2009, 80 (4), 640–645. (8) Walden, V. M.; Lamond, E.; Field, S. A. Container contamination as a possible source of a diarrhoea outbreak in Abou Shouk camp, Darfur province, Sudan. Disasters 2005, 29 (3), 213–221.
  5. 5. • Emergency guidelines not based on evidence from emergency settings Came from WHO GDWQ for cities • Not suitable for refugee camps • What’s important is water safety in the household! Core Problem
  6. 6. • Evidence-based guidance for water treatment in emergencies • UC Berkeley, UNHCR, MSF, HIF • 2014-2016: South Sudan, Jordan, Rwanda, Tanzania Previous Research
  7. 7. New Evidence-based Guidance
  8. 8. What would be ideal is to have a unique water treatment guideline for every site The Next Opportunity
  9. 9. …takes routine monitoring data and applies data analytics to generate customized water chlorination guidance for any field site that ensures water is safe to drink. Safe Water Optimization Tool
  10. 10. SWOT Schematics
  11. 11. SWOT System Architecture Courtesy: Mike Spendlove, Avanade Inc.
  12. 12. • Achmea Foundation & GCC Humanitarian Grand Challenge • Nov 2018 – Dec 2020 o User engagement o Back-end analytics o Front-end interface o Field trials in refugee camps (3) & Refinements o New applications: household water treatment, conflict zones, urban slums, intermittent water systems o Field trials (3) & Refinements o Chlorine taste & odour threshold research o Dissemination and scaling Development and Proof-of-Concept MVP = Minimum Viable Product
  13. 13. • Global Dataset on water quality  Determine influencers for chlorine decay and water safety • Climate: temperature & precipitation • Environmental hygiene Machine Learning Possibilities
  14. 14. Fin.

Editor's Notes

  • Waterborne diseases are among leading threats in humanitarian emergencies
    Safe water is essential for preventing these diseases
  • Chlorination is the main method for water treatment in emergencies
     Cheap, easy to use, offers residual protection
    However, current technical guidance is not based on any field evidence and often fails to ensure water is safe
  • MSF encountered this problem first hand during a major Hepatitis E outbreak in refugee camps in South Sudan, in 2012-13
    These guidelines were being implemented, but when household water safety was evaluated, we found that 40-60% of households that collected water from chlorinated sources had no detectable chlorine in their stored water (CDC)
    Researchers from the University of Barcelona also found human adenoviruses in stored water (human fecal contamination)
    So we saw in South Sudan that even though we were implementing and achieving the water treatment standards, the water had no chlorine protection and was fecally contaminated when people drank it -- all during a major waterborne disease outbreak!

    It turns out that this problem has been seen many times before:
    From Uganda, to Malawi, Kenya, to Sudan, there was a growing body of evidence that post-distribution contamination of treated water commonly occurs in refugee/IDP camps, and is often linked to the spread of waterborne diseases among camp populations

  • It turns out that the humanitarian guidelines for water treatment were not working because they were not based on any actual field evidence from emergency settings
    Instead, they were taken from the WHO GDWQ, which are based on conventions from municipal piped water systems…
    The chlorination targets in the WHO GDWQ guidelines only provide sufficient residual protection in situations where users drink water directly from the flowing taps of a piped network.

    In refugee/IDP camps on the other hand, users must collect water from camp distribution points (i.e., tapstands) – which is what you see in this image;
    Carry it in jerrycans and other receptacles to their shelters;
    And then store and use that water for 24 hours or more, all in settings where ambient hygiene may be quite poor.
    The temporal and spatial distance between distribution and consumption in refugee camps provides ample opportunity for contaminants (e.g., dust, fecal matter, microbes) to come into contact with treated water, consume chlorine residual protection, and result in pathogenic contamination.  

    What this made clear for us is that what is important is not water safety at the point of distribution – the tapstand – but water safety at the point of consumption – in people’s households.
    This was the disconnect in the available emergency water treatment guidelines!


  • In response to this gap, MSF launched research to develop the first evidence-based guidance for water treatment in emergencies

    In collaboration with UNHCR and the University of California Berkeley, MSF expanded this research to refugee in diverse environmental settings around the world between 2014-2016 including South Sudan, Jordan, Rwanda, and Tanzania

  • Through this foundational research we developed new evidence-based chlorination targets that are appropriate for different field conditions.
    This replaces the single, universal, non-evidence-based guideline

    Under the old guidelines, the proportion of households having actually safe water to drink was around 15-50%
    Under these new guidelines, we demonstrated we can improve the proportion to 70-85% or greater.

    We validated these guidelines at a new test site in Tanzania in 2016 and found them again to be effective for improving water safety at the point of consumption.

    They have been adopted by MSF for field use and are also being taken up by UNHCR.
    We have published this work in the Bulletin of the WHO, on MSF’s Field Research site, and soon it will be available in the leading open access journal PLOS One.

  • What would be ideal is to have a unique water treatment guideline for each site--that is appropriate for local conditions and demonstrated to ensure water safety at the point of consumption – in each camp.
    This is something we can achieve by applying the analytics we have already developed to the routine water quality data that are regularly collected for monitoring purposes by humanitarian sector agencies at every single refugee/IDP camp site.

  • We are therefore setting out with MSF to develop a new web-based water safety optimization tool that takes routinely collected water quality data and generates a custom water chlorination guideline for any site
    The tool will build on our previous work by bringing in a new machine-learning component so that our models can adapt to changing conditions in the field
  • Here’s how it works:
    Humanitarian agencies are already collecting huge quantities of water quality monitoring data that is underutilized (used mostly for reporting purposes).
    Field workers can upload the data to our web-based platform.
    Our platform utilizes cloud computing with multiple models to analyze the data (including the analytics we generated as part of the earlier research) as well as new machine learning enabled models that can help the system to adapt to changing conditions in the field
    To generate a robust a site-specific chlorination recommendation that ensures that water is safe where people drink it
  • High level system architecture
  • To build this tool and develop a robust proof of concept, we will
  • This tool is being developed and tested for applications in complex humanitarian emergencies (CHEs) and for use by humanitarian actors in refugee/IDP camp settings primarily.
    Humanitarian responses to complex humanitarian emergencies are typically financed on a charity model. Humanitarian responses are not profit oriented or even cost recovery oriented.
    In this case however, we expect significant cost offsets as a consequence of the application of this Safe Water Optimization Tool. For example, the cost of medical treatments for a waterborne infectious disease outbreak will be significantly reduced because the frequency and intensity of outbreaks and the number of patient cases will be reduced. This will significantly reduce the overall cost of providing humanitarian assistance and will be directly driven by the efficacy of the Safe Water Optimization Tool.

    Operating costs including website hosting, database, and cloud computing are small ($800-1800 USD per year) and can be defrayed through a combination of institutional hosting (from York University and MSF) and in-kind contributions from the private sector company that is supporting us on web product development (Avanade Inc., a division of Microsoft and Accenture). Our on-going technical support from Avanade Inc. will enable us to provide updates and improvements in the web-based platform in response to field and user needs.

    Once the tool is prototyped, tested, and its efficacy established in complex humanitarian emergencies, we will work with the research innovation commercialization and marketing office at York University (Innovation York) to develop additional applications of the Safe Water Optimization Tool beyond the humanitarian sector. We will use sub-licensing Intellectual property agreements to secure appropriate partnerships with the private sector so that its full impact can be realized. Applications of this tool beyond complex humanitarian emergencies include with water utilities seeking to optimize water safety in municipal water systems. The SWOT is especially relevant to water utilities operating intermittent water systems or household water treatment programs using chlorination, which are increasingly the norm in large developing world cities in Africa, Asia, and elsewhere. Other application spaces include in remote communities globally that are locally or cooperatively operated, or in indigenous communities in Canada where water quality is a major national concern. Each of these are potential markets for the Safe Water Optimization Tool. We will structure sub-licensing agreements to private sector users so that a portion of profits generated from additional applications beyond CHEs are used to fund the humanitarian applications of the Safe Water Optimization Tool in an ongoing and sustainable manner.
  • We have already begun developing connections with humanitarian sector agencies in order to support scale up throughout the sector.
    The Division of Programme Support and Management at UNHCR – the UN agency mandated with the protection and assistance of refugee populations and who run all refugee camps globally – have offered to support our project with access to field sites and by engaging with us on platform design. (UNHCR was also involved as a collaborating partner on the foundational research on which the current project builds).
    In addition, we have support from the Global WASH Cluster, the main sector-wide coordination mechanism for humanitarian WASH agencies, as well as from the Office of US Foreign Disaster Assistance (OFDA), on data sharing and field implementation.
    In addition, we will be working closely with MSF OCA and the other MSF operational sections who are often the first agencies into emergencies and set up systems that are then handed over to other agencies.
    Through these key agencies, we have direct pathway for sector-wide engagement on platform design, data-sharing, and scaling up.
  • Over the course of the project, our tool will improve water safety at one live field trial site (Bentiu, South Sudan) and two remote implementation sites (Mtendeli, Tanzania and Kigeme, Rwanda), representing an essential public health impact on the lives of 182,710 refugees and IDPs in crisis zones in sub-Saharan Africa.
    The pilot of this tool at these three sites will constitute a proof-of-concept for the Safe Water Optimization Tool, and be used to support its scaling throughout the humanitarian sector.
    It is our aim to transform safe water practice in the humanitarian sector by showing, through this project, that we can use artificial intelligence to analyse routinely collected monitoring data in order to optimize water safety in humanitarian emergencies globally.
    We will adopt, from project outset, an integrated user engagement and scaling strategy that will ensure operational alignment with humanitarian agencies as well as to cultivate change champions from across sector agencies.
    Our aim is to eventually cover all extant displacement crises in sub-Saharan Africa in the Democratic Republic of Congo, Burundi, Somalia, South Sudan, Central African Republic, Nigeria, and Mali, which affects more than 10.9 million people displaced (refugees and IDPs), and new ones that emerge in Africa and elsewhere globally in the future.

    The project will generate a new technology and advance research on the use of AI in humanitarian response – it will generate at least one scientific publications and several conference presentations to practitioner/academic audiences

    This innovation could therefore have widespread impacts throughout LMIC globally in terms of improving water safety and reducing the incidence of waterborne diseases. This in turn will have major downstream economic impacts in terms of productivity and healthcare expenditures saved. As an insurance industry leader, Achmea will benefit from increased economic productivity, improved public health status, greater societal stability, and improved resilience of the business environment in multiple LMIC countries
    With more than 65 million people displaced as of 2017, we are witnessing the highest levels of forced displacement ever recorded in human history. With increasing climate and political instability globally, the numbers of crises and displaced people are only expected to increase. This innovation fills an urgent operational gap on water safety and public health in conflict-affected settings, needed more than ever in this moment of unprecedented global crisis.

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