Presentation by Dr. Adrian Cashman of the Centre for Resource Management and Environmental Studies (CERMES) at the 5th High Level Session Ministerial Forum of the Global Water Partnership-Caribbean (GWP-C).
Reflections from the good practices of the Erhai Lake Basin Management Commis...CPWF Mekong
By Jianping Wang, Yunnan University, P.R. China, M-POWER Fellow
Presented at the Mekong Forum on Water, Food and Energy
Phnom Penh, Cambodia
December 7-9, 2011
Session 8a: Presenting the work of the M-POWER Fellows
Presentation by Dr. Adrian Cashman of the Centre for Resource Management and Environmental Studies (CERMES) at the 5th High Level Session Ministerial Forum of the Global Water Partnership-Caribbean (GWP-C).
Reflections from the good practices of the Erhai Lake Basin Management Commis...CPWF Mekong
By Jianping Wang, Yunnan University, P.R. China, M-POWER Fellow
Presented at the Mekong Forum on Water, Food and Energy
Phnom Penh, Cambodia
December 7-9, 2011
Session 8a: Presenting the work of the M-POWER Fellows
UN-Water Report Calls for Wastewater Focus in Post-2015 AgendaGraciela Mariani
#Wastewater
UN-Water Report Calls for Wastewater Focus in Post-2015 Agenda
Only 20 percent of global wastewater is currently being treated, leaving low-income countries hardest hit by contaminated water supplies and disease, according to the UN report which encourages governments to see treated wastewater as a valuable resource, and a priority for the post-2015 development agenda. This is accompanied by the realization that the focus on drinking-water and sanitation without due attention being paid to wastewater may have exacerbated some of the water quality problems seen globally. It is increasingly being recognized that the issues of wastewater management and water quality have cross-linkages with a range of other water- and non-water issues, not least in respect of the water, energy and food nexus. It has also been acknowledged that wastewater management clearly plays a role in achieving future water security in a world where water stress will increase. Against this backdrop, there is an emerging consensus on the need for a dedicated water goal in the post-2015 Development Agenda, one which includes explicit recognition of the importance of good wastewater management and its contribution to protecting water quality. The report ’Wastewater Management- A UN-Water Analytical Brief’ looks at some of the problems caused by the neglect of wastewater management, but also at the benefits and opportunities that can be realized through proper attention to this area, and highlights why it is crucial that wastewater management and water quality stop being the ’poor relations’ and receive attention in their own right.
#AguasResiduales
Informe de ONU-Agua destaca la importancia de las aguas residuales para la agenda post-2015
Sólo el 20% de las aguas residuales a nivel global están siendo tratadas, siendo los países de bajos ingresos los más afectados por las aguas contaminadas y las enfermedades, según señala el último informe de la ONU sobre aguas residuales. Dicho informe insta a los gobiernos a tratar las aguas residuales como un recurso valioso y como una prioridad para la agenda de desarrollo post-2015. Atender el agua potable y el saneamiento sin la debida atención a las aguas residuales puede haber exacerbado algunos de los problemas de calidad del agua presentes en todo el mundo. Se reconoce de manera creciente que la gestión de las aguas residuales desempeña claramente un papel en el logro de la seguridad hídrica futura en un mundo en el que la escasez de agua aumentará. En este contexto, existe un consenso emergente sobre la necesidad de una meta dedicada al agua en la agenda de desarrollo post 2015, que incluya el reconocimiento explícito de la importancia de una buena gestión de las aguas residuales y su contribución a la protección de la calidad del agua. El informe 'Gestión de las Aguas Residuales- Nota Analítica de ONU-Agua ' analiza algunos de los problemas causados por la negligencia de la gest
Presented by Sanjiv de Silva at the Regional Conference on Risks and Solutions: Adaptation Frameworks for Water Resources Planning, Development and Management in South Asia, on July 12, 2016, at Hilton, Colombo, Sri Lanka
Slides for the seminar on “Constructing ‘water worlds’: the social implications of technical systems in water governance”. Hosted by the Department of Sociology, University of Colombo, Sri Lanka.
he management of water resources has become a critical need in Bangladesh because of growing demand for water and increasing conflict over its alternative uses. As populations expand and make various uses of water, its growing scarcity becomes a serious issue in developing countries such as Bangladesh.
Nutrient pollution, defined as excess amounts of nitrogen and phosphorus in aquatic systems, is one of the leading causes of water quality impairment in the United States. This report compiles current information regarding the costs of nutrient pollution. Such costs may be of two broad types. Some costs are associated with reducing nutrient pollution at its sources. Other costs are associated with the impacts of nutrient pollution in the environment. The latter category of costs is referred to as “external costs” or “externalities,” because they are “external” to the owners of the farms, businesses, or facilities that generate them.
Monitoring Performance or Performing Monitoring? Lessons on the politics of m...IRC
By Katharina Welle, PhD candidate, University of Sussex. Prepared for the Monitoring sustainable WASH service delivery symposium, Addis Ababa, Ethiopia, 9-11 April 2013.
NGA Report: State Practices to Protect Drinking Water While Developing Shale ...Marcellus Drilling News
The National Governors Association (NGA) issued a 16-page report in July encouraging governors and their states to adopt policies that encourage a) the use of less drinking water for fracking, and b) the use of more recycling of flowback water in fracking. The report, titled "State Practices to Protect Drinking Water While Developing Shale Energy" (full copy below), is the result of a a 35-member panel that met in March.
Presentation by B. Ole Sander, International Rice Research Institute or research supported by CCAFS, the Climate and Clean Air Coalition, and USAID
International conference on agricultural emissions and food security: Connecting research to policy and practice
10-13 September 2018
Berlin, Germany
Bercermin dari Pembangunan Sanitasi di IndiaOswar Mungkasa
merupakan tulisan hasil pengamatan langsung dan bertukar pengalaman dengan penggiat sanitasi di India. Ditulis oleh Oswar Mungkasa (Pokja AMPL) dan dimuat dalam majalah PERCIK edisi Desember 2008
UN-Water Report Calls for Wastewater Focus in Post-2015 AgendaGraciela Mariani
#Wastewater
UN-Water Report Calls for Wastewater Focus in Post-2015 Agenda
Only 20 percent of global wastewater is currently being treated, leaving low-income countries hardest hit by contaminated water supplies and disease, according to the UN report which encourages governments to see treated wastewater as a valuable resource, and a priority for the post-2015 development agenda. This is accompanied by the realization that the focus on drinking-water and sanitation without due attention being paid to wastewater may have exacerbated some of the water quality problems seen globally. It is increasingly being recognized that the issues of wastewater management and water quality have cross-linkages with a range of other water- and non-water issues, not least in respect of the water, energy and food nexus. It has also been acknowledged that wastewater management clearly plays a role in achieving future water security in a world where water stress will increase. Against this backdrop, there is an emerging consensus on the need for a dedicated water goal in the post-2015 Development Agenda, one which includes explicit recognition of the importance of good wastewater management and its contribution to protecting water quality. The report ’Wastewater Management- A UN-Water Analytical Brief’ looks at some of the problems caused by the neglect of wastewater management, but also at the benefits and opportunities that can be realized through proper attention to this area, and highlights why it is crucial that wastewater management and water quality stop being the ’poor relations’ and receive attention in their own right.
#AguasResiduales
Informe de ONU-Agua destaca la importancia de las aguas residuales para la agenda post-2015
Sólo el 20% de las aguas residuales a nivel global están siendo tratadas, siendo los países de bajos ingresos los más afectados por las aguas contaminadas y las enfermedades, según señala el último informe de la ONU sobre aguas residuales. Dicho informe insta a los gobiernos a tratar las aguas residuales como un recurso valioso y como una prioridad para la agenda de desarrollo post-2015. Atender el agua potable y el saneamiento sin la debida atención a las aguas residuales puede haber exacerbado algunos de los problemas de calidad del agua presentes en todo el mundo. Se reconoce de manera creciente que la gestión de las aguas residuales desempeña claramente un papel en el logro de la seguridad hídrica futura en un mundo en el que la escasez de agua aumentará. En este contexto, existe un consenso emergente sobre la necesidad de una meta dedicada al agua en la agenda de desarrollo post 2015, que incluya el reconocimiento explícito de la importancia de una buena gestión de las aguas residuales y su contribución a la protección de la calidad del agua. El informe 'Gestión de las Aguas Residuales- Nota Analítica de ONU-Agua ' analiza algunos de los problemas causados por la negligencia de la gest
Presented by Sanjiv de Silva at the Regional Conference on Risks and Solutions: Adaptation Frameworks for Water Resources Planning, Development and Management in South Asia, on July 12, 2016, at Hilton, Colombo, Sri Lanka
Slides for the seminar on “Constructing ‘water worlds’: the social implications of technical systems in water governance”. Hosted by the Department of Sociology, University of Colombo, Sri Lanka.
he management of water resources has become a critical need in Bangladesh because of growing demand for water and increasing conflict over its alternative uses. As populations expand and make various uses of water, its growing scarcity becomes a serious issue in developing countries such as Bangladesh.
Nutrient pollution, defined as excess amounts of nitrogen and phosphorus in aquatic systems, is one of the leading causes of water quality impairment in the United States. This report compiles current information regarding the costs of nutrient pollution. Such costs may be of two broad types. Some costs are associated with reducing nutrient pollution at its sources. Other costs are associated with the impacts of nutrient pollution in the environment. The latter category of costs is referred to as “external costs” or “externalities,” because they are “external” to the owners of the farms, businesses, or facilities that generate them.
Monitoring Performance or Performing Monitoring? Lessons on the politics of m...IRC
By Katharina Welle, PhD candidate, University of Sussex. Prepared for the Monitoring sustainable WASH service delivery symposium, Addis Ababa, Ethiopia, 9-11 April 2013.
NGA Report: State Practices to Protect Drinking Water While Developing Shale ...Marcellus Drilling News
The National Governors Association (NGA) issued a 16-page report in July encouraging governors and their states to adopt policies that encourage a) the use of less drinking water for fracking, and b) the use of more recycling of flowback water in fracking. The report, titled "State Practices to Protect Drinking Water While Developing Shale Energy" (full copy below), is the result of a a 35-member panel that met in March.
Presentation by B. Ole Sander, International Rice Research Institute or research supported by CCAFS, the Climate and Clean Air Coalition, and USAID
International conference on agricultural emissions and food security: Connecting research to policy and practice
10-13 September 2018
Berlin, Germany
Bercermin dari Pembangunan Sanitasi di IndiaOswar Mungkasa
merupakan tulisan hasil pengamatan langsung dan bertukar pengalaman dengan penggiat sanitasi di India. Ditulis oleh Oswar Mungkasa (Pokja AMPL) dan dimuat dalam majalah PERCIK edisi Desember 2008
Isu Gender dalam Penyediaan Air Minum dan SanitasiOswar Mungkasa
Mengetengahkan isu gender dalam pembangunan AMPL. Dimulai dari filosofi, definisi, sejarah, dan pengarusutamaan gender. Ditulis oleh Oswar Mungkasa (Pokja AMPL) dan dimuat dalam majalah PERCIK edisi April 2007.
Financial modeling of public private partnership in wastewater treatmentIJARIIT
This article basically determines the assets in which water resources are polluted the environment by anthropogenic
sources like agricultural and household formation. As matter of fact, Public think that the environmental impact of wastewater
pollution has increased day by day many conventional wastewater treatment techniques like chemical adsorption. Hence the
activated sludge is applied to remove the pollution but there are still some limitations which have high operation costs. The use
of waste water treatment in public and private works as a different medium is receiving increased interest so that its low
operation and maintenance costs. As per as the water treatment is concerned it is easy to have a good effectiveness and ability
for degrading contaminant. Hence, this paper reviews is the use of waste water treatment technologies to remove contaminants
from wastewater like a high oxidant which represent the main pollutants in wastewater as per as a financial modeling of the
public private partnership of wastewater treatment.
Applications of Re-Engineered Productivity Award Model in the Measurement of ...IJAEMSJORNAL
The purpose of this study is to measure performance and identify operational strategies for improving water supply systems in Nigeria. Water has remained the most crucial element in the environment as mankind significantly depends on it for their existence. Performance metrics framework for productivity of water supply system (WSS) in Nigeria has thus far been underestimated hence the need for user friendly approach to effectively assess critical activities of the system. A re-engineered productivity award model (RPAM) adopted in this study consists of 10-point core measures that control overall performance of the WSS as well as other supportive measures for the realization of set goals of the system. The application of the model recorded a score of 44.08% which is an inducement to placing WSS on the threshold of significant achievement of strategic goals. This suggests possible adaptation of the model and improvement effort which has the capacity of addressing identified barriers to its implementation. The capacities of the strategic adaptive framework include creation of competitive platform for recognizing stakeholders who have greater influence in higher productivity solutions in water supply systems.
These slides cover the purposes for ecosystem service valuation (ESV), methods for valuation, examples of valuation studies, and government regulation and program related to ESV.
Urun Rembuk. Permukiman dan Ketahanan PanganOswar Mungkasa
pembangunan terkesan memanfaatkan tanah pertanian yang ditengarai dapat mengurangi produksi pangan. dengan demikian, dibutuhkan upaya yang masif agar pengalihan lahan pertanian tidak terjadi tanpa pengendalian.
Merengkuh kota ramah pejalan kaki dan Pesepeda. Pembelajaran Mancanegara dan ...Oswar Mungkasa
perkotaan mengalami banyak masalah disebabkan demikian intensifnya penggunaan moda kendaraan bermotor. sudah saatnya melirik alternatif lain yang lebih berkelanjutan yaitu moda berjalan kaki dan bersepeda
selama ini skema yang diperkenalkan adalah 3 R (Reuse, Reduce Recycle) kemudian dengan berkembangnya konsep ekonomi sirkuler maka berkembang pula skema lebih baru yang dikenal sebagai upcycling.
Green infrastructure in jakarta basic understanding and implementation effort...Oswar Mungkasa
The implementation of green infrastructure (GI) in Indonesia accelerated by public awareness of the importance of conservation of natural resources and ecosystems. One of the Indonesian government’s efforts to apply the principles of GI in urban areas in a structured and massive manner is through the Green City Development Program (P2KH) Ministry of Public Works and Public Housing (PUPR). The approach taken is Green Planning and Design, Green Open Space, Green Energy, Green Water, Green Waste, Green Building, Green Transportation, Green Community. The city that is the case study for discussion is Jakarta. Jakarta Smart City, Green Buildings, Urban Agriculture, and Child Friendly Integrated Public Space (RPTRA) are programs that successfully implemented. The implementation GI program easily accepted if based on the community.
Tata Kelola Kolaboratif dalam Desain Kebijakan Publik. Studi Kasus Pelaksanaa...Oswar Mungkasa
artikel ini didasarkan pada kenyataan bahwa tata kelola kolaboratif telah diadopsi dalam hampir seluruh dokumen pebangunan di Indonesia namun dalam kenyataannya masih belum sepenuhnya dapat dilaksanakan. untuk itu, makalah ini mencoba memetakan kondisi yang ada berdasar pada pembelajaran maupun studi kasus pelaksanaan SDGs di indonesia. kemudian memberikan pilihan langkah strategis dalam uaya memperkuat tata kelola kolaboratif di indonesia
Fakta, Isu dan SAran Penyempurnaan BP TAPERAOswar Mungkasa
oleh Oswar Mungkasa
FGD Daring Optimalisasi Peran, Fungsi dan Pelayanan Badan Pengelola Tabungan Perumahan Rakyat (BP-TAPERA) bagi Penerima Manfaat Paska
Housing and Urban Development Institute
Jakarta, 24 Juni 2020
LAPORAN. Memori Akhir Jabatan Koordinator Pelaksanaan Program Strategi Ketaha...Oswar Mungkasa
disiapkan sebagai bagian dari pertanggungjawaban dan keterbukaan informasi publik
Kolobarasi yang berkelanjutan adalah kunci
mewujudkan Ketahanan Kota Jakarta”
Oswar M. Mungkasa
Presentation. Collaboration Towards A Resilient JakartaOswar Mungkasa
Collaborative approach in solving issues of Jakarta to build resilience
Oswar Mungkasa (Former Chief Resilient Officer of Jakarta 100 Resilient Cities Program)
Advocacy Forum on Giving Inputs to the Implementation of the New Urban Agenda in Myanmar - CORDAID Yangon, 22nd January 2020
Pengenalan konsep saleh sosial dalam pembangunan sanitasiOswar Mungkasa
Tulisan ini disiapkan untuk memeriahkan ajang NTU (Nugroho Tri Utomo) Writing Contest for Water and Sanitation 2019 bertema Menuntaskan Akses Sanitasi dan Air Minum Aman Berkelanjutan 2024 yang diselenggarakan oleh Jejaring Air Minum dan Penyehatan Lingkungan (AMPL).
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Incentivizing Investments and Ensuring Cost Recovery for Operating Wastewater Treatment
1. Editorial Manager(tm) for IWA Conferences
Manuscript Draft
Manuscript Number: IWA-7742R1
Title: Incentivizing investments and ensuring cost recovery for operating wastewater treatment
systems in Asia
Article Type: Full Paper
Keywords: Cost recovery; Economic benefits; Financing; Performance monitoring; Wastewater
treatment
Corresponding Author: Jonathan Neil Parkinson, B. Eng (Hons) MSc DIC PhD
Corresponding Author's Institution:
First Author: Jonathan Neil Parkinson, B. Eng (Hons) MSc DIC PhD
Order of Authors: Jonathan Neil Parkinson, B. Eng (Hons) MSc DIC PhD;Anand Chiplunkar, PhD
Manuscript Region of Origin: UNITED KINGDOM
2. (Initial page layout)
Motivating investments and promoting sustainability of
DEWATS
J.N. Parkinson *, A.Chiplunkar **, I. Blackett ***
* International Water Association, Alliance House, 12 Caxton Street, London SW1H OQS (E-mail:
jonathan.parkinson@iwahq.org)
** Asian Development Bank, 6 ADB Avenue, Mandaluyong City 1550, Metro Manila, Philippines (E-mail:
achiplunkar@adb.org)
** Water and Sanitation Program, Indonesia Stock Exchange (BEI), Jakarta, 12190, Indonesia (E-mail:
iblackett@worldbank.org)
Abstract
There are considerable economic benefits associated with investments in improved sanitation and
excreta management. However, existing policy frameworks are ineffective in the translating these
benefits into the necessary financial incentives that are required to mobilise capital investment and
to ensure financial sustainability. Bearing this in mind, the authors consider why it is proving to be
so difficult to instigate any comprehensive change. To overcome the current status quo, the
authors argue for a need to approach wastewater management from a more localised perspective in
which standards and strategies for achieving these standards are developed in close partnership
with local stakeholders using results from cost benefit analysis to support the decision-making
process. The authors make the case that an important part of the process is to ensure that all
economic benefits are monetized and realised at different levels. In addition, financial incentives
linked to performance of wastewater treatment plant operators is considered to be key towards
achieving environmental objectives.
Keywords
Cost benefit analysis; Cost recovery; Economic benefits; Financing; Performance monitoring;
Regulation; Wastewater treatment; Water quality standards
INTRODUCTION
A lack of urban sanitation coverage and systems for collection and treatment of wastewater, septage
and fecal sludge is widespread throughout Asia. Even in situations where systems exist, facilities
and infrastructure are frequently poorly operated and maintained. As a result, waterbodies
throughout the region continue to be degraded by pollution from uncontrolled discharges of
untreated wastewater arising from inadequate and incomplete urban sanitation systems. The two
main impacts are those that directly affect human health as a result of transmission of waterborne
diseases and those that degrade the quality of water resources and the environment.
Some governments recognize the significance of these impacts and have developed policies which
aim to protect the health of the populations and the water resources within the counties that they
govern. However, even where such policies exist, the Asian Development Bank (ADB) and other
agencies still find it challenging to get policy makers and managers at national and local
government levels to translate these policies into practice and develop strategies to tackle
wastewater management. A typical example comes from China where it is estimated that only 56
percent of municipal wastewater is treated, and often not to acceptable standards. As a consequence,
the Hai River is the most polluted river in the PRC and more than 50 percent of surface water in the
river basin is rendered unusable for any beneficial use (MEP 2010). This is not an unusual situation
in China and also applies in other parts of Asia. This situation is paradoxical given the fact that
there are obvious health and environmental benefits that can be achieved as a result of investments
in improving coverage and waste management.
Even in situations where investments have been made, the efficacy of the investments to reach the
desired result is severely compromised when wastewater treatment assets are poorly operated or
maintained. For example, a report by the Central Pollution Control Board (CPCB) in India revealed
final paper for DEWATS conference
Click here to download Manuscript: Motivating investments and promoting sustainability of DEWATS - submission 07.05.11.doc
3. that up to 39 percent of wastewater treatment facilities in the country breached environmental
regulations (CPCB, 2005). In China, more than 1,000 wastewater plants were built between 2000
and 2006, but the utilization rate is only 60 percent. About 50 plants in 30 cities are operating at
below 30 percent capacity, and some are left idle, mainly because of inadequate wastewater
collection facilities and because revenues collected from customers are transferred to the general
city budget and not used to ensure that treatment plants have the resources needed to operate.
Operational efficiency is also low, mainly because plants carry out only primary treatment. Even in
Shanghai the efficiency is only 10–30 percent (Shalizi 2008).
Additionally, there is also a lack of institutional capacity and resources in national agencies to
regulate effectively; especially given the high costs incurred in establishing and maintaining
effective regulatory instruments. This may be as a result of the use of inappropriate and
unsustainable technologies which were installed in pursuit of aspirational standards. This situation
is exacerbated by the uniformity and inflexibility of standards set by central government agencies.
The fact that wastewater discharge standards in developed countries have been developed
progressively as societies reached higher levels of affluence and environmental awareness is
frequently overlooked (Johnstone and Horan 1996). Government monitoring and enforcement
programs are having only limited impact, because of selective application of the laws and low levels
of fines at the provincial and central levels, combined with weak enforcement of rules at the local
level, which diminish the deterrence value of regulations. Regulations are also incomplete insofar as
load-based standards are absent and the standards that are set are not achievable given China’s
current technological capabilities (Shalizi 2008).
In this paper, the authors explore the economic benefits of sanitation and wastewater treatment in
relation to the health benefits, reduced pollution of surface and groundwater and wastewater reuse.
They consider how the economic benefits may be translated into financial incentives to provide an
incentive for wastewater systems to be well operated and maintained. The applicability of
centralised standards and regulation is also open to question and other more localised and
incremental forms of regulation need to be considered.
ECONOMICS OF SANITATION AND WASTEWATER MANAGEMENT
Some studies focus on the health benefits in the household domain whilst others focus more on the
benefits of wastewater treatment. The Water and Sanitation Program’s (WSP) Economics of
Sanitation Initiative (ESI) has looked comprehensively at both the household and public domain
and, based upon this analysis, Parkinson and Blume (2010) summarize the following economic
benefits:
• Time benefits: as a result of closer access to a toilet and shorter waiting times at public
toilets (resulting in additional time for work or study), and time gains associated with caring for the
sick.
• Health benefits: increased productivity and income; reduced expenditure on health care.
• Education: increased attendance at school and improved cogitative ability.
• Improved water quality: reduced costs of provision of water supply for drinking and other
purposes, and enhanced productivity of aquatic (and to a lesser extent terrestrial) ecosystems.
• Environment quality: increased land value due to enhanced environmental conditions.
• Tourism: potential for increased revenue from tourism.
These benefits can have a substantial impact on the economy as a whole which can be quantified in
terms of the benefit to people whose livelihoods depend upon the quality of the environment. In this
respect, although economic analysis is based on an ’human centred’ viewpoint on the value of the
environment, it provides a useful way of identifying and subsequently quantifying the full range of
impacts. The benefits that are not directly attributable to the proposed intervention are known as
externalities. For example, these may relate to reuse of treated water which can have positive
externalities related to the increase in water availability and potential savings in the use of
agricultural fertilizers. The less tangible but nonetheless important economic benefits relate to
aesthetics, such as when an area becomes more attractive to live and work in; thus increasing land
prices and real estate.
4. QUANTIFICATION OF ECONOMICS BENEFITS
Economic benefits that cannot be attributed directly to financial expenditures or revenue can be
quantified in monetary terms and there are various methodologies that can be employed for this
purpose. Cost-benefit analysis (CBA) is widely accepted as a decision-making support tool to
compare the economic viability of different proposals in which benefits are compared using a
common analytical methodology. Shadow pricing is a way of monetising environmental benefits in
which wastewater treatment benefits are calculated as the equivalent of the environmental damage
avoided. All identified benefits are translated into a common monetary language and economic
viability occurs where benefits outweigh costs and the result is positive.
Economic benefits of sanitation
In South East Asia, the ESI study commissioned by WSP estimated that Cambodia, Indonesia, the
Philippines and Vietnam (WSP (2007) lose an aggregated USD 2 billion a year in financial costs
due to poor sanitation (equivalent to 0.44% of their GDP) and USD 9 billion a year in economic
losses (equivalent to 2% of their combined GDP). These figure are important for advocacy purposes
to lobby politicians to invest in improved sanitation. However, further analysis of the results is
necessary to understand what benefits are attributed towards household level sanitation and what
are attributed to investments in additional facilities and infrastructure for wastewater treatment. As
an example of how these cost may be disaggregated, Table 1 shows the benefit-cost ratios and cost
per disability life year averted (DALY) by intervention in urban areas in the Philippines. The results
are presented for ideal settings in which it is assumed that facilities are performing according to
their design and also under actual settings which takes into consideration the fact that many
facilities are not well operated or maintained and therefore the actual benefit realised is lower than
the design value.
Table 1. Benefit-cost ratios of various types of urban sanitation in the Philippines (Rodriguez et al
2010). Note: These results are not for citation as they are draft and unpublished.
Cost per
disability life
year averted
(DALY) (ideal
setting)
000 pesos
Benefit-cost ratios in
urban areas, by
intervention
under ideal
settings
under actual
settings
Shared and
communal
facilities
Community toilets 131 2.9 1.7
Shared toilets 115 2.3 1.3
On-site
sanitation
(household
level facilities)
Pour flush to pit 126 5.1 3.3
Urine Diversion Dry
Toilet
459 1.5 1.3
Pour-flush toilets to
septic tank
No desludging 430 5.1 4.1
Sludge collected and
treated off-site
383 3.8 2.7
Waterborne
sanitation and
wastewater
treatment
Sewers connected to
decentralized
conventional
treatment
434 4.3 3.6
5. The results show that all interventions show positive economic benefits which justifies the need for
investment and potentially the use of targeted subsidies. The lower cost sanitation options deliver
relatively high economic benefits for each unit of investment, but when actual performance is taken
into account, the reduced cost-effectiveness ratios strengthen the case for off-site treatment where
there is greater opportunity for greater management control and therefore improved performance.
The results also show that the installation of communal and shared toilets can be a cost-effective
way of reducing the transmission of diarroheal diseases as indicated by the relatively low costs per
DALY averted. But these costs are observed to be relatively high (> 3000 US$), which is attributed
to the relatively low rate of child mortality in the Philippines, meaning that deaths account for the
major share of the DALY burden. But the DALY results do not consider the environment benefits
related to waste treatment and/or reuse and providing low cost sanitation access (as in MDG)
without proper disposal of wastewater or sludge still leads to degradation of environmental quality.
Economic benefits of wastewater treatment and reuse
The results from the WSP study in the Philippines presented above indicate either comparable or
higher cost benefits of investments in waterborne sanitation and wastewater treatment relative to
other investments. However, the results from other studies demonstrate that the economic benefits
depend upon the type and use of the receiving water into which the wastewater is discharged. For
example, Hernández-Sancho et al (2009/2010) used CBA to assess the economic viability of
various types of wastewater treatment plants (WWTPs) in Spain. The lowest relative benefit was
identified to be in those situations where wastewater is discharged into the sea due to the dilution
and dispersion of pollution in marine waters. The greatest environmental benefit was found to be
associated with discharge into wetlands because these areas have high ecological value and are
more sensitive to pollution. Interestingly, nutrient removal (in particular phosphorus) was identified
to be the most cost-beneficial form of wastewater treatment; whilst treatment of suspended solids
was observed to be the least environmentally beneficial action. Molinos-Senante et al (2010b) also
concluded that phosphorus recovery is viable not only from sustainable development perspective
but also from an economic point of view.
With respect to the quality of wastewater for reuse in agriculture, Lavee (2011) analysed the
implications on the cost–benefit of wastewater treatment plants in Israel as a result of changes in the
regulatory standards. The study showed that the introduction of stricter standards (and therefore
more costly wastewater treatment plants) would result in greater net economic benefit when all the
expected benefits are monetized. Haruvy (1997) compared various wastewater reclamation and
reuse options in Israel looking at the implications of changes in treatment levels and location of
reuse. Estimated costs include those of treatment, storage and conveyance, while benefits comprise
the value of agricultural output, the decrease in fertilization costs, and aquifer recharge.
Environmental impacts that were considered in the analysis related to contamination of groundwater
by nitrates and resultant health risks. According to the analysis, wastewater irrigation may save
US$0.50-0.60 per cubic metre of wastewater compared with river disposal in the center of Israel.
Hernández-Sancho et al (2009/2010) also looked into the economic benefits of reuse of treated
wastewater. They found that the sale of treated wastewater resulted in an average net profit for the
wastewater treatment and concluded that reuse offers significant economic benefits because it
reduces the pressure on conventional water resources, whilst simultaneously reducing pollution of
receiving water courses.
BENEFITS OF DECENTRALISED APPROACHES TOWARDS WASTEWATER
MANAGEMENT
Clearly there are economic benefits in investing in both toilets (household, communal and public)
and systems for collecting, treating and reusing wastewater. The key question remains whether this
is best achieved at the local level using decentralised systems or at a large scale using centralised
systems. There is no global answer to this, as the economic viability of sanitation systems is
dependent on site-specific conditions and the potential for the productive use of the waterbodies
into which the residual wastes are discharged. However, given the high costs of centralised
6. sanitation systems, it is logical to move towards a system in which the economic benefits are
realised as locally as possible.
The greater the level of decentralization, the more opportunity there is to bring wastewater
management down to a local level whereby the economic benefits are more effectively realised by
local stakeholders. Evidently, in denser urban areas, decentralised systems become difficult to
construct once developments have already used all available space. But it should not be assumed
that decentralised systems cannot be installed in urban areas as there are often pockets of urban land
that can be used for smaller wastewater management facilities. In these situations, the use of the
land for wastewater treatment is not necessarily a technical problem, but more a socio-political
decision.
Setting and regulating standards for wastewater disposal
As noted above, standards set by centralised agencies can be restrictive and constrain investment.
This is particularly a problem for decentralised systems which are not always capable of achieving
high standards, unless a three-stage treatment process is adopted. The failings of the uniform
standard approach adopted by central government agencies necessitates a need to consider policies
and standards that are congruous with local needs. Johnstone and Norton (2000) note that the
assimilative capacity of the water body is different in different environmental settings and
accordingly the standards can be linked to the intended beneficial uses. Thus, in some cases, there
may be a need to introduce new or amend existing standards where unrealistic standards have
already been introduced. Johnstone and Norton (2000) concluded that there is a need for a phased
approach to the introduction of standards. Von Sperling (2000) describes further the benefits
associated with a stepwise implementation of standards to achieve a gradual improvement of the
water or wastewater quality,
Even though researchers working in specific situations have shown that higher standards can result
in higher economic gains and are therefore justified, this approach requires additional capital which
is often lacking. Given this situation, a phased introduction of investment may be an alternative,
although this too needs to be costed for the specific situation. For example, satisfying the European
Union’s water quality objectives for minimum dissolved oxygen is estimated to require a capital
investment of about US$ 65 million, whereas a lower standard of 6 mg/l would cost US$ 26 million
and a year-round minimum DO standard of 4 mg/l would cost US$ 13 million (Somlyody and
Shanahan 1998). In Asia, the costs may be quite different depending upon the type of technology
adopted which will impact upon the results from the CBA. CBA is also influenced by operational
and maintenance costs (OPEX) but these data are scarcer. According to EPSAR (2009), the average
WWTP operating costs are 0.12, 0.26 and 0.32 €/m3 for primary, secondary and tertiary treatment
respectively. These are only indicative as these data are specifically relevant to the Spanish context,
but nonetheless illustrate the fact that different levels of treatment required considerably different
levels of investment.
PARTICIPATION FROM LOCAL STAKEHOLDERS
One of the other key benefits of the decentralised approach is that it provides greater opportunity to
involve stakeholders in the derivation of policy and standards that are appropriate for the local
context. Enforcement by local stakeholders may be considered as means to regulate and to hold
those responsible for pollution accountable. The development of policies to prevent the degradation
and depletion of water resources requires determining their value in social and economic terms and
incorporating this information into the decision-making process (Hernández-Sancho et al 2010).
Thus, as well as the catchment approach being logical from a technical perspective (i.e. to derive a
pollution control strategy that is approach for local water bodies), it also make sense from the
perspective of ensuring that local stakeholders are in agreement with the proposed standards and the
strategy for pollution reduction in light of the costs incurred.
This approach is being promoted in Brazil where implementation of the PRODES programme
which was launched in 2001. PRODES requires that a river basin committee (RBC) is operative and
is involved with the implementation of water charging in the basin and effluent discharge reduction
7. levels approved by the committee. It requires also that a social agreement is entered into between
legitimate representatives of all stakeholders: the Federal Government through the Brazilian
National Water Agency (ANA), the State Governments; the private sector and civil society
legitimate representatives. Subsequently the RBC should agree to the investment programme via an
agreement signed with the Municipal Authority.
POTENTIAL FOR OUTPUT BASED FINANCING TO INCENTIVISE INVESTMENTS
AND PROMOTE OPERATIONAL SUSTAINABILITY OF DEWATS
The PRODES programme launched in Brazil described above involves an innovative financing
facility that aims to encourage public and private companies to implement new treatment plants and
to improve the performance of existing wastewater treatment systems based upon a system of
financial incentives according to the monitored reduction in pollutant loads. The concept of the
programme is innovative because, instead of financing civil works and equipment, it finances the
implementation of new wastewater treatment plants via a series of financial instruments based upon
the treatment of wastewater according to a set of predetermined standards. ANA also provides
financing for expansion or retrofitting of treatment plants, provided that these are able to lead to
improvements in the pollutant load removed and treatment plant efficiency. Payments are made
available only after the achievement of the agreed goals on water quality indexes are demonstrated.
The assessment of compliance of the treatment plant is made by ANA according to a set of rules,
based on a process of self-evaluation and auditing, which specifies sampling frequency, compliance
percentage and other criteria. Oliveira et al (2007) argue that this approach has considerable
potential as part of a comprehensive pollution mitigation strategy. This approach may have potential
for application in Asia, but success is dependent on the development of a standardised framework of
performance evaluation for regulatory purposes.
CONCLUDING REMARKS
In contrast to water supply and sanitation services, the benefits of wastewater treatment are less
obvious to individuals and also more difficult to assess in monetary terms. Although wastewater
treatment has many associated environmental benefits, these are often not calculated because they
are not set by the market (Molinos-Senante et al 2010a). There is however an increasing body of
evidence that indicates that wastewater treatment is economically viable but this depends on the full
range of environmental benefits being included in the analysis. In general, studies show that more
complete and advanced systems that achieve higher standards of environmental health are also more
cost-beneficial per unit of investment. There are however more costly and therefore require greater
levels of investment as well as more advanced systems for operation and maintenance.
Therefore, the two main constraints are access to finance and development of technical and
managerial capacity to be able to operate and maintain wastewater systems. Underlying both of
these constraints is the lack of political incentive to invest in the first place and lack of incentive
from an operational perspective to ensure that systems are well operated. The results from financial
and economic analysis can play a key role in advocacy to politicians that investing in sanitation and
wastewater management systems is cost-beneficial and does not necessary result in an ongoing
drain in financial resources if local stakeholders sign up to a policy that is perceived to result in
environmental health improvements that will benefit the local community. Identifying the
appropriate standards is key in this process as they need to be congruous with these demands and
the local context.
There is therefore a need to develop and apply methodologies for economic analysis that can be
used to support decision-making and policy development at the local level rather than using the
results from other studies to make generic conclusions about the applicability of specific
technologies. Central governmental regulatory agencies should embrace these contemporary
approaches and consider how they make work effectively with local authorities to support decision-
making and policy development at the local level. These approaches are envisaged to have greater
potential for achieve more widespread and long-term improvements in sanitation and wastewater
management than are currently achieved.
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