- International Network on Household Water Treatment

Scaling Up the HypoSol For SAFE
Water: A Philippine Strategy
MADELINE J. RETUTA, M.D.,MPH
DOH, Center For Health
Development For LuPangIlocos
2008 International Symposium
on Household Water Management
2-5 June 2008, Accra, Ghana
Contents
• Background
• Responsibility sharing
• Strategies
• Drivers of uptake
• Sustainability
• Barriers and solutions
• Lessons learned
The Philippines
ƒTotal population: 88.5 M
ƒ 3 major islands
ƒ15 regions
ƒDiarrhea still in
the top 10
leading causes
of morbidity for
20 years
The Philippines
•11,338 people die
each year or
31 people die each
day from diarrhea
resulting from poor
sanitation and
hygiene
( WB-USAID
Study, 2008)
Access to Safe Drinking Water
and Sanitary Toilet, Philippines
100
90
80
70
60
50
40
30
20
10
0
91.5
87.7
81.8
83
73.9
75.4
Access to safe
Drinking Water
Access to Sanitary
Toilet Facility
2005
2006
2015
Source: FHIS 2005-2006; MDG Target 2015
The Philippines
•13 million people
are at risk due to
lack of access to
safe water source
(PEM-WB,
June 2007)
Devolved Health System
NATIONAL GOV’T
(DOH)
LOCAL GOV’T
Implementation
Policy-making
Advocacy
Monitoring/evaluation
CENTERS FOR
HEALTH
DEVELOPMENT
( CHDs)
PROVINCIAL
GOV’T
MUNICIPAL
GOV’T
The HypoSol For SAFE Water
Project
BRINGING CLOSER ACCESS TO SAFE
DRINKING WATER IN EVERY HOME
The HypoSol For SAFE Water Project Framework
2004
BACKGROUND
SITUATION
2005-2006
2006-2007
PILOT TEST
UPSCALING
EXPANSION
2007present
( REGIONWIDE)
(NATIONWIDE )
NATIONAL HWTS
NETWORK
The Situation
Fig. 1
SPOT MAP OF CONFIRMED CHOLERA CASES, PANGASINAN
MAY 28, 2004 – DECEMBER 31, 2004 N=476
Bolinao
Anda
45
Pangasinan
Bani
Sison
Alaminos City
San Fabian
Pozzurubio
Agno
San Nicolas
PANGASINAN
San Manuel
Sual
San Jacinto
Mangaldan
Burgos
Lingayen
Binalonan
Manaoag
Binmaley Dagupan City
Natividad
Laoac
Asingan
Calasiao
Dasol
Mabini
San Quintin
Mapandan
Labrador
Tayug
Urdaneta City
Sta.Barbara
Sta.Maria
San Carlos City
Malasiqui
Infanta
Villasis
Rosales
Bugallon
Basista
Urbiztondo
Sto.Tomas
Alcala
Bayambang
Aguilar
Bautista
Mangatarem
Balungao
Umingan
Fig.2 CONFIRMED CHOLERA CASES PER MUNICIPALITY
LA UNION JUNE 1- OCTOBER 22, (N=152)
LEGEND
NO. OF CASES
In three months: June-September, 2004
Total of 9,975 Acute Gastroenteritis
( AGE ) cases; 55 deaths ( mostly children )
High risk water
sources
Immediate Intervention
• Household Container Disinfection ( HCD)
( Hypochlorite granules)
Low Compliance:
ƒ Tedious preparation
ƒ Short shelf life ( 1 week)
ƒ People refused to drink the end product due
to smell and taste
SITUATION
Need for an
immediate, interim
intervention
Cholera epidemic,2004
Constraints in establishing
long term piped water
structures
Introduction
of the SWS
by the
WHO
MDG, Ten-point agenda
of the president ( 2010)
CHD-1
PILOT TEST
CONSTRAINTS
PILOT
Product
unavailable
locally
1. Immediate
implementation
2. Upscaling, expansion,
sustainability
CONSTRAINTS
PILOT
Product
unavailable
locally
1. Immediate
implementation
( DOH, WHO, CDC,
AMANTIRTA Project in
Indonesia )
SOLUTION
Imported
product
1.25% Sodium Hypochlorite
Solution ( HYPOSOL )
Nalsian
Norte &
Cabatling
Bolinao
7
7
1
1
%
%
Payar
& Isla
Anda
45
Pangasinan
Bani
Sison
Alaminos City
San Fabian
Pozzurubio
Agno
San Nicolas
PANGASINAN
San Manuel
Sual
San Jacinto
Mangaldan
Burgos
Lingayen
Binalonan
Manaoag
Binmaley Dagupan City
Natividad
Laoac
Asingan
Calasiao
Mabini
Dasol
San Quintin
Mapandan
Labrador
Urdaneta City
Sta.Barbara
San Carlos
City
Infanta
Tayug
Sta.Maria
Malasiqui
Villasis
Rosales
Bugallon
Basista
Urbiztondo
Balungao
Umingan
Sto.Tomas
Alcala
Bayambang
Aguilar
Bautista
Mangatarem
2005-2006: PILOT TEST
PILOT
Efficacy of the
solution
CHD-1
Social
acceptability
Knowledge
and practices
Impact on
diarrhea
reduction
Private
Sector
DOH/CHD,
WHO,CDC
as technical
advisory
Preparations
for local
production
Results
9 Solution was effective
9Acceptable
9Improved practices
9Promising trend in
diarrhea reduction
Local product was
successfully registered
with the Bureau of Food
and Drugs
2005-2006
PILOT
Positive
results from
the pilot study
NATIONAL
POLICY
LOCAL
PRODUCT
LOCAL
ORDINANCES
UNICEF
NGOs
AO 2007-0005
ACADEME
MEDIA
UPSCALE
2006-2007
Scale Up sites: Pangasinan (7 municipalities)
Bolinao
Anda
45
Pangasinan
Bani
Sison
Alaminos City
San Fabian
Pozzurubio
Agno
San Nicolas
PANGASINAN
San Manuel
Sual
San Jacinto
Mangaldan
Burgos
Lingayen
Binalonan
Manaoag
Binmaley Dagupan City
Natividad
Laoac
Asingan
Calasiao
Dasol
Mabini
San Quintin
Mapandan
Labrador
Tayug
Urdaneta City
Sta.Barbara
Sta.Maria
San Carlos City
Malasiqui
Infanta
Villasis
Rosales
Bugallon
Basista
Urbiztondo
Sto.Tomas
Alcala
Bayambang
Aguilar
Bautista
Mangatarem
Balungao
Umingan
Scale Up site: La Union ( 1 city )
LEGEND
NO. OF CASES
AMORE COVERED
PROVINCES
NON-ARMM SITES = 43 BARANGAYS
ARMM = 184 BARANGAYS
COLOR LEGEND:
Yellow = Non-ARMM
Blue = ARMM
ACCESS TO SAFE WATER:
A GIFT OF LIFE TO THE
COUNTRYSIDE
WATER SCENES IN AMORE-COVERED BARANGAYS
Water Peddling/rationing is a thriving business in island-villages where water is considered scarce.
Mostly, dug wells in the islands yield water with mild to high salinity contents.
Most of the wells in the island-villages are unprotected, and thereby susceptible to contamination.
Result of the Bacteriological Test
conducted in one of the AMORE site in
Maguindanao.
RESPONSIBILITY SHARING
Level of Participation of key stakeholders
SITUATION
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
NATIONAL GOVERNMENT
L
O
C
A
L
P
R
O
D
U
C
T
( DOH/CHD-1)
LOCAL GOVERNMENT
PILOT
PRIVATE SECTOR
( Local Production)
UNICEF,NGOs
ACADEME,MEDIA
UPSCALING
RELIGIOUS GROUP
EXPANSION
Areas of collaboration
Main Stakeholders
NATIONAL
GOV’T
POLICY, OVERALL
MANAGEMENT
CHDS
POLICY, PROVISION OF
LOGISTICS,
IMPLEMENTATION AND
MONITORING
LOCAL
GOV’T UNITS
LOCAL
PRODUCER
ADVOCACY
AND HEALTH
PROMOTION
PRODUCT PROMOTION
NGOs
RELIGIOUS
GROUP
IMPLEMENTATION,
TECHNICAL, AND
LOGISTICAL ASSISTANCE
MEDIA
WHO,UNICEF
TECHNICAL, LOGISTICAL ,
AND FINANCIAL
ASSISTANCE
Logistics sharing
Logistics provision
SITUATION
( DOH/CHD-1, WHO)
PILOT
Fully subsidized
LOCAL GOV’T
UNICEF,NGO
RELIGIOUS
UPSCALING
EXPANSION
Partially subsidized
Expansion sites : Pangasinan (21 municipalities)
Bolinao
Anda
45
Pangasinan
Bani
Sison
Alaminos City
San Fabian
Pozzurubio
Agno
San Nicolas
PANGASINAN
San Manuel
Sual
San Jacinto
Mangaldan
Burgos
Lingayen
Binalonan
Manaoag
Binmaley Dagupan City
Natividad
Laoac
Asingan
Calasiao
Dasol
Mabini
San Quintin
Mapandan
Labrador
Tayug
Urdaneta City
Sta.Barbara
Sta.Maria
San Carlos City
Malasiqui
Infanta
Villasis
Rosales
Bugallon
Basista
Urbiztondo
Sto.Tomas
Alcala
Bayambang
Aguilar
Bautista
LEGEND
Mangatarem
NO. OF CASES
SCALE UP SITES
EXPANSION SITES
Balungao
Umingan
Expansion sites: La Union ( Province-wide)
LEGEND
NO. OF CASES
SCALE UP SITES
EXPANSION SITES
STRATEGIES
STRATEGIES
1. POLICY FORMULATION
NATIONAL GOV’T, CHDS
WHO as technical
advisor
LOCAL GOV’Ts
Republic of the Philippines
CITY OF SAN FERNANDO
Province of La Union
RESOLUTION NO. 07-34
RESOLUTION STRONGLY ENJOINING HOUSEHOLDS, BUSINESS
ESTABLISHMENTS AND PRIVATE/GOVERNMENT OFFICE IN THE
CITY OF SAN FERNANDO TO USE SODIUM HYPOCHLORITE
SOLUTION (HYPOSOL) AS CHLORINE SOLUTION FOR RAW OR
CONTAMINATED WATER AND FOR CONTAINER DISINFECTION.
STRATEGIES
2. MULTISECTORAL ALLIANCES
Pledge of Commitment Among Key Stakeholders
STRATEGIES
2. MULTISECTORAL ALLIANCES
I. ADVOCACY AND
AWARENESS
CAMPAIGNS
ADVOCACY AND AWARENESS CAMPAIGNS
WITH DONORS AND POLICY MAKERS
ADVOCACY AND AWARENESS CAMPAIGNS
FAMILIES AND COMMUNITIES
ADVOCACY AND AWARENESS CAMPAIGNS
IN SCHOOLS: PUPILS AND STUDENTS ARE
VERY GOOD ADVOCATES OF POU
ADVOCACY AND AWARENESS CAMPAIGNS
RELIGIOUS LEADERS ARE A STRONG
INFLUENCE AMONG MEMBERS
ADVOCACY AND AWARENESS CAMPAIGNS
THE MEDIA
ADVOCACY AND AWARENESS CAMPAIGNS
PROJECT VISIBILITY DURING
EVENTS AND FESTIVITIES
ADVOCACY AND AWARENESS CAMPAIGNS
OUTBREAK RESPONSE
ADVOCACY AND AWARENESS CAMPAIGNS
POLITICAL EVENTS
STRATEGIES
3. MONITORING
STRATEGIES
CONSULTATIONS
AMONG LOCAL
PRODUCER,
PRODUCT EXPERTS,
AND PROJECT
MANAGEMENT TO
ENSURE PRODUCT
QUALITY,
AVAILABILITY AND
ACCESSIBILITY
3. MONITORING
STRATEGIES
AMONG LOCAL
EXECUTIVES,
IMPLEMENTORS, AND
USERS TO ADDRESS
PRESSING ISSUES
3. MONITORING
STRATEGIES
TO LOOK INTO THE
PROGRESS OF
IMPLEMENTATION AND
TO BOOST THE MORALE
OF HEALTH WORKERS
3. MONITORING
DRIVERS OF HFSW UPTAKE
DRIVERS OF
UPTAKE
UPSCALE
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
L
O
C
A
L
P
R
O
D
U
C
T
POCKETS OF
OUTBREAKS
“FEAR” FACTOR
BEHAVIOR
CHANGE
TESTIMONIES/EXPERIENCES
OF IMPLEMENTORS AND
CURRENT USERS
IMPACT ON DIARRHEAL
CONTROL
EXPANSION
2007-PRESENT
UPSCALE
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
DRIVERS OF
UPTAKE
COSTEFFECTIVENESS
L
O
C
A
L
P
R
O
D
U
C
T
ECONOMICAL
ADVOCACY ON THE
BENEFITS OF THE
STRATEGY
EXPANSION
2007-PRESENT
SUSTAINABILITY
I. PASSAGE OF LOCAL ORDINANCE
II. Resolution No. 07-34
Resolution strongly enjoining households, business
establishments and private/ government offices in
the City of San Fernando to use Sodium
Hypochlorite solution (Hyposol) as Chlorine
solution for raw or contaminated water and for
container disinfection.
25th day of September 2007
II. Inclusion of the HFSW
logistics in the regular
budget of the CHDs,
LGUs, and partner
organizations.
III. Integration of the HFSW in the
regular programs/projects of
the government
IIIA. Water and Sanitation
programs/projects
IIIB. Maternal and Child Health
and Nutrition Program
MOTHERS’
CLASSES
FOODHANDLERS’
CLASSES
IV. EPIDEMIOLOGICAL INVESTIGATION
ACUTE GASTROENTERITIS (AGE)
SURVEILLANCE
V. BOTIKA NG BARANGAY
VI. RESEARCH
HEALTH , SOCIAL, ECONOMIC AND
IMPACTS
BARRIERS AND SOLUTIONS
UPSCALE
CONSTRAINT
TECHNICAL
RESOURCES FOR
IMPLEMENTATION
UPTAKE: Food Vs.
Water treatment
SOLUTION
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
L
O
C
A
L
P
R
O
D
U
C
T
EXPANSION
HFSW PROGRAM PACKAGE
STRENGTHEN AND
SUSTAIN ADVOCACY
GOV’T AND CIVIL
SOCIETY SUBSIDIES
FOR THE POOREST
OF THE POOR
2007-PRESENT
UPSCALE
CONSTRAINTS
MARKET LINKAGES
AND PRODUCT
PLACEMENTS
SOLUTION
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
L
O
C
A
L
P
R
O
D
U
C
T
EXPANSION
Manufacturer –
Distributor’s forum
2007-PRESENT
UPSCALE
CONSTRAINTS
MARKET LINKAGES
AND PRODUCT
PLACEMENTS
SOLUTION
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
L
O
C
A
L
P
R
O
D
U
C
T
EXPANSION
Identify potential,
local distributor/s
and link them up
with the regional
distributor or
manufacturer.
Assist them in the
development of
the market
arrangement.
2007-PRESENT
UPSCALE
CONSTRAINTS
MARKET LINKAGES
AND PRODUCT
PLACEMENTS
SOLUTION
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
L
O
C
A
L
P
R
O
D
U
C
T
EXPANSION
Company Direct
Sales
Independent
Distributors /
Traders
Cooperatives &
NGO initiatives
BOTICA NG
BARANGAY
2007-PRESENT
UPSCALE
CONSTRAINTS
POLITICAL
LANDSCAPE
1. Preference for
infrastructures
2. Low
confidence in
the low-cost
technology
3. “ To see is to
believe “
SOLUTION
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
L
O
C
A
L
P
O
L
I
C
I
E
S
L
O
C
A
L
P
R
O
D
U
C
T
EXPANSION
PROJECT IMPACT IN
DISASTER / OUTBREAK
RESPONSE
Cost of the intervention
and impact on diarrhrea
reduction
2007-PRESENT
LESSONS LEARNED
9Political will at the national and
local levels is vital in the
institutionalization of
mechanisms to carry out and
sustain any project/program
LESSONS LEARNED
9Strong multi-sectoral alliances
stimulate cooperation and
action among stakeholders
and helps build sustainable
local and national capacities.
LESSONS LEARNED
9Project management that is
dedicated and focused on the
GOALS AND OBJECTIVES
LESSONS LEARNED
9Regular consultations
among project
management, implementers
and beneficiaries
generate trust and
confidence in the strategy
CHALLENGE
N
A
T
I
O
N
A
L
P
O
L
I
C
Y
EXPANSION
L
O
C
A
L
P
O
L
I
C
I
E
S
L
O
C
A
L
P
R
O
D
U
C
T
W
A
Y
O
F
REGIONWIDE
NATIONWIDE
L
I
F
E
HWTS PROGRAM
HWTS NETWORK
2007-PRESENT
IN SUMMARY:
• Government-led, anchored
in multi-sectoral alliances,
impact driven, towards a
National HWTS network.
Think
BIG
Start small,
Act now
KEEP GOING
( never wait) !
THANK YOU
The HFSW Project Team was conferred the First Public Health
Bayani Award by the Philippine Public Health Association in their
Diamond Jubillee Celebration, July, 2007