Facilitating behaviour change for the adoption of 'non-treatment' options for the implementation of the 2006 WHO wastewater use guidelines Pay Drechsel, Hanna Karg and Eline Boelee Presented at the IWA session "Hygienic Risks of Sanitation Systems" at the networking weekend of "Water and Health: Where Science Meets Policy" The University of North Carolina at Chapel Hill, USA. October 23-24, 2010

1. Facilitating behaviour change for the adoption of ‘non-treatment’ options for the implementation of the 2006 WHO wastewater use guidelines Pay Drechsel, Hanna Karg and Eline Boelee Presented at the IWA session “Hygienic Risks of Sanitation Systems” at the networking weekend of “Water and Health: Where Science Meets Policy,” The University of North Carolina at Chapel Hill, USA. October 23-24, 2010

2. Content Risk situation & options to mitigate risk Cost-effectiveness of these mitigation options Ways to support their adoption on farm and in street food restaurants Example: Ghana

4. Food for 10% of global populationMain driver: Water Scarcity Source: Jiménez and Asano, 2008; Scott et al., 2010.

5. 2006 Guidelines Source: www.who.int/en/

6. Wastewater generation Farmer/ Producer Traders/Retailers Street food kitchens Consumer Safe IrrigationPractices HygienicHandlingPractices Safe food washing and preparation Wastewater treatment Awareness creation to create demand for safe produce Facilitating behaviour change via education, financial & non-financial incentives, and regular inspections Multi-barrier approach  low-income countries Source: Ilic, S.; Drechsel, P.; Amoah, P.; LeJeune, J. 2010

7. Wastewater and faecal sludge treatment plants in Ghana Source: Murray & Drechsel, 2011

8. Wastewater and faecal sludge treatment plants in Ghanatreat in urban areas < 10% of ww How many of them work ? 13% operating +/- as designed 30% have some rest capacity 57% (un)officially broken down Source: Murray & Drechsel, 2011

9. Photo Credit: IWMI

10. Photo Credit: IWMI

11. Are at risk every day in Ghana’s 5 biggest cities: 2,500- 3,000farmers and traders of exotic vegetables 20,000-26,000 staff ofstreet foodrestaurants, 610,000- 860,000 street food consumers  ca. 12,000 lost DALYs* annually (without family members) *DALYs: Disability Adjusted Life Years Source: IWMI, 2009

12. Wastewater generation Farmer/ Producer Traders/Retailers Street food kitchens Consumer Safe IrrigationPractices HygienicHandlingPractices Safe food washing and preparation Wastewater treatment Awareness creation to create demand for safe produce Facilitating behaviour change via education, financial & non-financial incentives, and regular inspections Applied, participatory action research Source: Ilic, S.; Drechsel, P.; Amoah, P.; LeJeune, J. 2010

13. PHILIP AMOAH

14. Low-cost interventions at one or more entry points could avert up to 90% of DALYs* DALYs: Disability Adjusted Life Years Source: Amoah et.al. 2011, forthcoming publication

15. video.google.com Source: IWMI, WHO

16. How much would it cost to avert the DALYs? Costing the promotion & implementation of interventions Costs to farmers (e.g. to buy and repair a drip kit) Cost to kitchen staff (e.g. to buy chlorine tablets) Costs to society (e.g. to train and monitor farmers) QMRA* with and without different interventions Cost-effectiveness analysis (US$ per DALY* averted) *QMRA: Quantitative Microbial Risk Assessment *DALYs: Disability Adjusted Life Years

17. Cost-effectiveness of interventions(Price of gaining 1 healthy life year) Adoption rate US$/DALY* averted On-farm Off-farm 75% + 75% $ 87 75% + 25% $ 94 25% + 75% $ 95 25% + 25% $ 394 One new small WWTP*/city ca. $ 4000 (5 cities) *DALYs: Disability Adjusted Life Years *WWTP: Waste Water Treatment Plant Source: Seidu and Drechsel, 2010

18. Hazard comparison for Accra, Ghana, via different exposure pathways Workers exposed at WWTPs Faecal sludge disposal exposure Flooding of main river passing city Failure of WWTP Contaminated drinking water pipes Swimming at Accra's beaches 94 $/DALY Wastewater irrigated vegetables >500 $/DALY Children exposed to open drains *DALYs: Disability Adjusted Life Years , *WWTP: Waste Water Treatment Plant Sources: Labite et al., 2010; IWMI, 2009

19. Success of treatment options depend on appropriate technologies, and incentives supporting responsive maintenance systems non-treatment options depend on incentives for individual behavior change (lasting adoption)

20. Why should farmers/traders/consumers change their behavior? Existing risk awareness/social responsibility/self-protection Investments in education & awareness creation Enforced regulations (control & punitive fees) Market demand for safer crops supported by a higher consumer willingness-to-pay Financial incentives (subsidies on farm inputs, credit access, payments for environmental services, …) Non-financial trigger and incentives (prestige, fear, etc.)

21. What could trigger behavior change? 1. Consumers Visual neatness of food, trust in trader, and (low) price. Risk awareness is marginal + too many other risk factors!  Disgust could be an effective trigger to change habits (Ghana’s hand-wash campaign)

23. Positive image, safety awards (<-> media pressure) Financial incentives: Market-access, credit

25. High willingness to avoid complaining customers

26. Customer satisfaction

28. Whom would you listen to? Food Vendors Farmers Source: IWMI, unpub.

29. Visualizing messages Imported vs. local symbols Source: www.fightbac.org

30. To make the invisible risksvisible These two symbols were not understood by the target group, but tests with GlitterBug lotion were promising (www.glitterbug.com). Source: clipart, office.microsoft.com Source: www. pdclipart.org

31. More research needed on  Many opportunities to learn from the WASH sector! Financial and social incentives valid in the local context Social marketing to promote non-treatment options Triggers for behavior change Source: www.who.int/en Source: www.wsscc.org

32. Reference Wastewater Irrigation and HealthAssessing and Mitigating Risk in Low-income Countries Earthscan 2010 • 400 pages Free online: www.idrc.ca/openebooks/475-8/ or www.iwmi.org/Publications/Books/index.aspx

33. Other related publications Labite, H.; Lunani. I.; van der Steen, P.; Vairavamoorthy, K.; Drechsel, P.; Lens, P. 2010. Quantitative microbial risk analysis to evaluate health effects of interventions in the urban water system of Accra, Ghana. Journal of Water and Health, 8(3):417-430. Murray, A. and P. Drechsel. (in press). Positive deviance in the sanitation sector in Ghana: Why do some wastewater treatment facilities work when the majority fails? Waterlines Vol. 30 Amoah, P.; Keraita,B.; Akple.M; Drechsel,P.; Abaidoo, R.C.; Konradsen,F. 2011. Low cost options for health risk reduction where crops are irrigated with polluted water in West Africa. IWMI Research Report 141, Colombo (forthcoming) For more information, please visit www.iwmi.org