This is a lecture on the WASH programme of the WHO, and planning and implementation of some selected programmes (topics) in Environmental Health.

1. World Health Organization WASH
Projects
Planning and Implementation of
Environmental Health Programmes
By
Dr Olatunde Ajibola
MBBS (Lagos) MSc (Bournemouth)

2. What is the WASH?
WASH is an acronym for ‘Safe drinking-water,
Sanitation and Hygiene’.
Universal, affordable and sustainable access to WASH
is a key public health issue and is the focus of the two
targets of Sustainable Development Goal 6 (SDG 6).
 "Access to WASH" includes safe water, adequate
sanitation and hygiene education.
Safe WASH is not only a prerequisite to health, but
contributes to livelihoods, school attendance and
dignity and helps to create resilient communities
living in healthy environments.

3. Statistics
2.1 billion people globally lack safe water at home (2015).
Of those people:
 263 million spend more than 30 minutes per round trip
collecting water.
159 million people drink directly from surface sources,
such as streams or lakes.
844 million do not have basic drinking water services.
The target of the WHO & UNICEF is for UNIVERSAL &
EQUITABLE ACCESS TO SAFE WATER FOR ALL BY 2030

4. 4.5 billion people globally have no toilets at home that
safely manage excreta (2015).
Of those people:
2.3 billion still do not have basic sanitation services
892 million defecate in the open
600 million share a toilet or latrine with other
households.
The target of the WHO & UNICEF is universal and
equitable access to safe sanitation for all by 2030.

5. Access to water and soap for handwashing:
Varies immensely worldwide
Only 1 in 4 people in low-income countries have hand
washing facilities with soap and water at home
Only 14% of people in sub-Saharan Africa have hand
washing facilities
76% of people in Western Asia & Northern Africa have
hand washing facilities.
Soap and water for handwashing in all homes by 2030 is a
target of the WHO and UNICEF

6. WASH CONT’D
Lack of sanitation contributes to about 700,000 child
deaths every year due to diarrhea, mainly in LMI
countries.
Chronic diarrhea can have long-term negative effects on
children, in terms of both physical and cognitive
development.
Safe and sufficient WASH plays a key role in preventing
numerous NTDs such as trachoma, soil-transmitted
helminths and schistosomiasis
Lack of WASH facilities at schools can prevent students
(especially girls) from attending school, and reduce their
educational achievements and later work productivity.

7. A Brief History of WASH
 WHO’s work has always included WASH since its
inception in 1948.
 It was also a key component of the Health for All by the
Year 2000 launched in 1978.
 More recently, Water Action Decade 2018-2028, was
launched by the UN Secretary-General, calling for a
global action for WASH in all healthcare facilities
(HCF).
 The WHO WASH Strategy 2018-2025 takes on board
the need for progressive realization of the human rights
to safe drinking-water and sanitation, adopted by the
UN General Assembly in July 2010, as well as enshrined
in the SDGs

8. History Cont’d
The 2025 end date of the Strategy is
proposed to allow both a reasonably
manageable forward-looking time
period as well as time to adopt a new
WHO strategy in 2025 to enable course
corrections in the final five-year period
of the SDGs.

9. WHO Vision for WASH
To substantially improve health
through the safe management of
water, sanitation and hygiene
services in all settings.

10. WHO’s Principles of WASH
• Prioritize actions with the highest public health
benefit in areas where WHO has or can build
comparative advantages;
• Strengthen health sector capacities in promoting
safe WASH and taking up its public health oversight
role in WASH, including effective outbreak response
systems;
• Align with the SDGs, specifically targets relating to
WASH, health, climate change and nutrition, as well as
human rights principles;

11. WHO’s Principles of WASH
 Employ the highest quality science including through
collection, review and use of evidence about WASH
impacts on health and a full range of practical
experiences when developing norms and good practice
procedures;
 Stimulate sustainable change by strengthening
government institutions and systems charged with
implementation, oversight and regulation of WASH
service delivery;
 Promote a contextual, incremental improvement
approach when supporting countries to set national
WASH standards and ambitious but achievable national
targets

12. Planning and Implementation of
Environmental Health Programmes
 Environmental health comprises of those
aspects of human health, including quality of
life, that are determined by physical, chemical,
biological, social and psychosocial factors
in the environment. It also refers to the theory
and practice of accessing, correcting, controlling
and preventing those factors in the environment
that can potentially affect adversely
the health of present and future generations.

13. Definition of EH Cont’d
 ‘Environmental Health relates to the impact the
environment can have on a population.
 The environment refers to both the natural
environment and the human created environment.
 The natural environment on its own may create
problems for human health. Examples are: tidal waves
(tsunami), landslides, volcanic eruptions, heat
waves/stroke, etc.
 The created environment also poses many dangers to
health. For example the slums of many cities are a health
hazard due to poor housing (causing TB, malaria) and
poor availability of water & sanitation

14. EH Cont’d
 In low- and middle-income countries (LMIC), the
emphasis is on the improvement of basic sanitary
services – water supply, disposal of human excreta and
other solid and liquid wastes, vector control, food
sanitation, housing, protection from radiation and air
quality/control of pollution.
 In high-income countries, additional topics such as
occupational health & safety, transport management,
noise control and environmental impact assessment are
emphasized.
 Many of these problems are dealt with by non-health
sector professionals such as civil engineers and town
planners.

15. P & I of EH Programmes
Household air pollution (HAP) and poor WASH
constitute the most important causes of global disease
falling in the realm of environmental health.
Interventions, such as household water treatment, clean
cookstoves, and improved sanitation facilities have great
potential to yield reductions in disease burden.
Thus, in the following slides we shall focus on how to
solve the problems falling under EH, most especially in
the LMICs.

16. Water Supply
Water is a basic human right and essential need.
Industrial uses include the irrigation of crops, the
generation of electricity and for transport, such as in
canals and seas.
Domestic uses (freshwater, mainly) include:
o Drinking
o Personal hygiene
o Cleaning, e.g. cooking utensils
o Gardening, e.g. garden vegetables
A minimum of 20-40 Litres per person per day is required
for drinking, personal hygiene and cleaning.
Drinking water must be free from chemical and biological
contamination, plus being of acceptable colour, taste &
smell

17. Sources of Fresh Water
Surface water, e.g. streams, rivers, lakes and ponds
• Most easily accessible source of water
• But most prone to contamination
Ground water, e.g. wells and springs
• Of higher quality than surface water
• May be difficult to extract , e.g. submersible pumps may
be needed
Rainwater, as harvested off buildings
• In some places, it is an acceptable culture to collect
rainwater. It is of good quality if surface areas on which
it’s collected are kept clean.

18. Protection of Sources of
Freshwater
Surface water sources need more protection than
ground water.
However, both need to be protected.
Human faeces and animals are the greatest sources of
Contamination.
Protection can be through the construction of physical
barriers such as fences and walls and/or through
hygiene promotion.
Good planning is essential too, e.g. ensuring pit latrines
are not constructed within 30m of a shallow well

19. Storage of Freshwater
Storage containers should be well protected
from outside contamination
Be used for no other purpose
Have an opening which is small and a tight-
fitting lid
Health promotion efforts are required to
ensure storage containers are used properly.

20. Treatment
 In many instances some form of treatment will be
necessary.
 Surface water sources tend to require the greatest level
of treatment
 whereas spring water may not require any treatment at
all.
 Depending on the quality of the raw water the following
are the stages of treatment that may be followed:
Flocculation & sedimentation
Filtration
Disinfection

21. Flocculation and Sedimentation
Here the purpose is to remove as much solid matter
from the water as possible.
Flocculation involves the addition of alum (aluminium
sulphate), which acts as a coagulant which allows
suspended matter to sink and settle out as suspension.
 The aim of flocculation and sedimentation is to reduce
the turbidity to less than 5 Nephelometric Turbidity
Units (NTU) which facilitates the disinfection process.

22. Filtration
 Filtration is aimed at not only removing remaining
particulate matter but also pathogenic organisms.
 Filtration may also be used to remove chemical
contaminants in water.
 Slow Sand Filtration is the best known method of
filtration - it is the passing of water through a
combination of small stones and sand

23. Disinfection
 Disinfection is the last stage in the treatment process
and is aimed at killing pathogenic organisms in the
water.
 Chlorination is the most common form of disinfection.
 In municipal treatment plants, chlorine gas is used,
while on a small scale other forms of chlorine are used,
such as granules or tablets, e.g. calcium hypochlorite.
 When water is disinfected, a residual of chlorine is left
in the water to deal with additional contamination
once the water leaves the point of treatment up to the
point of consumption
 A normal residual chlorine is 0.2 – 0.5 mg/Litre.
 Compares the above with the residual swimming pool
chlorine of 1.5 – 2.0 mg/Litre

24. Distribution
 A supply of water fit for human consumption has to
be distributed in an equitable manner while its quality
is maintained.
 There are two options:
• individual family connections
• public water points.
Individual water points are common in the high-
income countries but less so in the LMICs.
 Public water points are most common in LMICs
where individual family connections cannot be
afforded.

25. Distribution: Public Water Points
Important issues to consider around the provision of
public water points:
i. Access - travel time should be little; queue time
should be minimal
ii. Presence of containers – families need containers
for the hygienic collection of water. Normally two
20-litre jerrycans per family is considered sufficient.
iii. Maintenance and protection of water points from
contamination or pollution.
iv. Drainage of waste water

26. End Use of Water
The point of consumption is the critical point at which
water supply need to be free from pathogenic
organisms.
 All the work in providing water in sufficient quantity
and of high quality will be lost if consumers do not
display hygienic practices and behaviour.
This is the point where hygiene promotion/education
plays a vital role.

27. Testing of Water Supplies
Physical, biological and chemical parameters should be
tested for when a new water supply source is provided.
 The frequency of periodic testing is determined by the size
of the population served.
 A water supply’s turbidity, smell and taste are the physical
xtics to look out for .
 Number of faecal coliforms is the biological parameter to
check. A number geater than 10 coliforms/100ml indicates
an unacceptable level of contamination.
 Chemical contaminants can include nitrates, phophates,
fluoride, arsenic and iron.
• For example, the critical level for arsenic is 0.01mg/Litre

28. EXCRETA DISPOSAL
 Human excreta is an important source of pathogenic
organisms, especially the causative agents of
diarrhoeal diseases.
 Furthermore, faeces are attractive to flies who not
only spread pathogenic organisms contained in the
faeces but also breed in them.
 The disposal of human excreta therefore is of major
public health significance.

29. Latrines or Toilets
Objectives of latrines or toilets:
 To dispose of potentially dangerous excreta
 To prevent the proliferation of vectors that might breed
in such waste
In the tropics there are two basic choices of excreta
disposal:
 pit latrines;
 pour flush toilets

30. Factors Determining Either a Toilet
or Latrine
The choice of system depends on the following factors:
 Adequate site planning
Availability of water
Soil type
Skills present in the community
Water table
Existing culture of excreta disposal within the
community
 Availability of material and financial resources

31. PRINCIPLES OF EXCRETA DISPOSAL
STRUCTURES
 They should be safe. For example it should not be
possible for small children to fall into a latrine pit.
 They should be built using hygienic and easy to clean
materials. For example the floor of latrines should be
made from a hard and durable material such as
concrete rather than compacted soil.
 They are accessible to all sections of the community
including the young and the old.
 They are designed to minimize the proliferation and
harbourage of disease vectors such as flies and
mosquitoes.

32. PRINCIPLES OF EXCRETA DISPOSAL
STRUCTURES cont’d
o They provide a degree of privacy to the users.
o They are located to avoid the potential of
contaminating water sources. For example they should
be a minimum of 30 m and preferably downhill from a
water source.
o They avoid the need to handle fresh faeces.
o There should be no contamination of surface soil

33. Pit Latrines
 Pit latrines are the most basic of excreta disposal systems
and are further divided into two main types:
i. The simple pit latrine
ii. The VIP (ventilated improved pit) latrine
 The simple pit latrines are characterized by their
simplicity in design.
 Unfortunately, they are often also characterized by the
presence of a foul smell and huge numbers of flies.
 The simple pit latrine is usually dug to a depth of 2 m
and is 1–1.5 m in diameter.

35. Simple Pit Latrines cont’d
In ideal conditions the liquid part of the waste
percolates out through the surrounding soil leaving the
solid matter behind.
 Heavy clay soils will prevent the percolation of liquid
resulting in a shorter lifespan for the latrine and more
conducive conditions for the vectors of disease.
 Sandy soils, although providing good percolation, are
prone to collapse.
 The pits of latrines in sandy soils therefore need to
be lined to prevent collapse.
 The floor slab is often made from concrete or timber
but in some cases it is compacted soil over sticks.

36. Simple Pit Latrines cont’d
The floor should be raised up 150 mm above ground
level to prevent the possibility of surface runoff water
entering the latrine pit.
 The drop hole in the floor slab is sometimes provided
with a cover to prevent the escape of foul smells and to
prevent access/escape for disease vectors such as flies.
The superstructure is usually made from local materials
such as mud and wattle, bamboo and sugar palm thatch
or timber and tin sheeting.
 Problems associated with the simple pit latrine include
– the presence of a foul smell and large numbers of
disease vectors, namely flies, mosquitoes (culex) which
cause filariasis, and cockroaches

37. VENTILATED IMPROVED PIT (VIP) LATRINES
 The ventilated improved pit (VIP) latrine is designed to
eliminate the common problems of the simple latrine,
namely foul smells and enabling conditions for disease
vectors.
 The principal difference from the simple pit latrine is
the addition of a ventilation pipe, which is normally
placed outside the superstructure.
 The vent pipe should be 110–150 mm in diameter and
extend at least 0.5 m above the roof.
 The top of the vent pipe must be fitted with a fly-proof
screen with a mesh size of 1 mm and should be made
from a non-corrosive material.

38. A VIP Latrine

39. VIP Latrine cont’d
The superstructure must also be kept dim.
How It Works
The VIP latrine works due to the passing of wind over
the top of the vent pipe which acts like a conventional
chimney.
The wind creates a draft of air up the vent pipe and
down into the pit through the drop hole.
Effects of the Airflow Direction
 It prevents foul smell from emanating from the pit
Flies present or breeding in the pit, having been drawn
up the vent become trapped by the fly-proof vent, and
die there because the airflow direction traps them .

40. Pour Flush Toilets
 The alternative to the pit latrine is the pour flush
latrine.
The pour flush latrine also has the added advantage of
preventing foul smells and removing easy access for the
vectors of disease.
 It is however dependent on ample supply of water all year
round and a population who knows how to use a pour flush
lantrine properly
 There are two types: the offset type has the pit to the rear
of the superstructure, which allows for easy access when it
comes to the emptying of the latrine.
 The pour flush latrine works when a seal of water is
maintained in the U-bend, thus preventing smells coming
out and preventing flies and mosquitoes from getting in or
out.

41. Outline of a Pour Flush Latrine

42. Disposal of Excreta
These are the options available when latrines or pour
flush latrines are full:
i. For pit latrines it is often possible to dig a new hole
and build a new superstructure or move the existing
superstructure over the new hole.
ii. In some countries, they have a system of two pits
which are used alternatively, allowing the contents of
one pit to be removed and used as compost/fertilizer.
iii. Pour flush latrines may need a vacuum truck to pump
out the waste and dispose of it in another location .

43. Disposal of Excreta: Sewerage
Sewerage is the method of disposing of excreta by a
water carriage system.
 It is used mainly in high-income countries.
 Toilets connected to sewers are of the pour flush
variety, commonly known as the water closet (WC) in
the Northern hemisphere.
 The water used in flushing -about 9 litres per flush in
the UK – is used to transport excreta through a network
of sewers or pipes to a treatment plant.
 Each treatment plant is a collection point for additional
transport, possibly out to sea or may discharge directly
to a water course

44. Waste Management
Types of waste common to LMICs, apart from human
excreta, include:
 Domestic waste, i.e. food waste
 Waste water, i.e. From bathing and other domestic
washing
 Medical waste, i.e. syringes
 The dead
 Industrial waste
Failure to manage the above wastes properly pose
increases the risk of infectious disease

45. Waste Management: Domestic
The management of domestic waste or refuse is further
broken down into storage, collection, recycling and/or
disposal.
 Domestic waste normally consists of organic material
such as food waste and inorganic objects such as
bottles, tins and packaging, etc.

46. Storage of Domestic Waste
 This is the first stage
 Sufficient containers or bins are needed to cope with the
volume of waste prior to collection.
 The containers need to be suitable by limiting opportunities
for vectors of disease such as flies and rats to feed on and
breed in the waste
 Organic waste may be composted directly without the need
for storage and collection
 Inorganic waste such as paper, tins and glass may be
recycled.
 Often in LMICs, people dispose of waste once it is produced;
good practice in this regard entails the placing of waste in a
pit and, dependent on the moisture, it can be burned or
buried.

47. Collection of Waste
 The collection of domestic waste should be at regular
and consistent intervals, wherever possible.
 The frequency of collection will often depend on the
capacity and quality of the storage containers used.
 Collection workers need protective clothing and
education in order to reduce the risk of infection to
themselves.

48. Domestic Waste: Disposal
The correct disposal of waste is very important and
there are a number of options available.
 The system of disposal needs planning from the very
beginning and must consider the types of waste being
produced, the volume of waste being produced and the
best disposal method within the circumstances.
 Common disposal methods include:
• Landfill
• Burning
• Composting

49. Disposal of Domestic Waste:
Landfill
 Landfill is the most common method of domestic waste
disposal.
 Basically it consists of four steps:
i. depositing waste in a planned controlled manner
ii. spreading and compacting it in layers to reduce its
volume
iii. covering the material with a layer of earth
iv. compacting the earth cover.
 Landfills are often located in the periphery of large
cities.

50. Disposal of Domestic Waste:
Burning
Burning is possible where the moisture content of the
waste is low.
 Burning does have a number of disadvantages in that
the burning of refuse in close proximity to domestic
dwellings (particularly if made of highly flammable
materials such as bamboo and thatch) creates an
additional fire risk in addition to producing
atmospheric pollution.

51. Disposal of Domestic Waste:
Composting
Composting is best suited in
situations where waste high in
organic matter content is
produced.

52. WASTE WATER
 Waste water from bathing & domestic use if not drained
properly, can accumulate creating conditions conducive to
the proliferation of disease vectors namely mosquitoes.
 In addition, washing water containing phosphates may also
cause problems when discharged into water courses in
excessive quantities.
 In the absence of a sewerage system, the common solution
to waste water at the individual household level is the use of
a soak pit, sometimes referred to as a soakaway.
 The soakaway allows the waste water to percolate into the
surrounding soil
 The pit is filled with stones to prevent its collapse, and is
covered with a plastic or tin sheet prior to topsoil going on
top.

53. MEDICAL WASTE
 Medical waste is potentially harmful.
 It can be divided into two:
 Sharps
 pathological wastes
Sharps (syringes and needles etc.) should be placed in
sealed containers, often tin boxes and sometimes filled
with disinfectant. When full, they should be buried to a
depth of at least 1 metre.
 All non-metallic wastes which have been in contact
with body fluids need separate collection and disposal.
Disposal should be in the form of incineration.

54. The Dead
Generally, dead bodies pose minimal health risk unless
they have died from a highly infectious disease such as
cholera in which case they need to be disposed of as
soon as possible.
 The specific method of disposal is cultural:
 Some opt for burial (Christians and Muslims)
 while others opt for cremation (Buddhists and Hindus).
If burial is chosen, sufficient space needs to be
allocated, and a suitable site found which considers soil
conditions and water depth to be favourable.
 If cremation is the option sufficient fuel must be
available

55. Industrial Waste
 The types of industry responsible for the majority
of hazardous waste include:
 the food and agricultural processing industry,
 metal extraction and processing,
 cement works,
 the paper industry,
 oil refining and the chemical industry.
 Industrial waste of public health importance includes:
 ‘tailings’ from the mining industry disposed of on land
 organic waste from abattoirs discharged into water courses
 emission of sulphur dioxide into the atmosphere from a
number of industries including the petrochemical industry
etc.

56. Principles Guiding Industrial
Waste
 Planning: This ensures that potentially culpable
companies are not sited in close proximity to
concentrations of human population or fragile
communities.
 Design: such industries need to design sufficient
mechanisms for the safe disposal of such waste or at
least to dispose of such waste within acceptable limits
that are not harmful to the environment or to health.
Research: Research is continually needed to monitor
the effects of industrial waste so that adjustments can
be made in setting safe limits or even banning the
production of certain wastes.

57. Many thanks for listening