Facing two water crises: Having enough water and ensuring it's safe to drink

A market vendor in Bamako, Mali buys Aquatabs water purification tablets for her shop from a Palladium sales promoter. The tablets are one of several solutions for ensuring safe water at point of use. Photo: David J. Olson

This was originally published on Global Health TV on March 29, 2018.

We talk about a world water crisis like there’s only one but there are really two. The first crisis we see playing out in Cape Town – the growing number of places that do not have enough water of any kind. The second crisis is ensuring that the water people do have is safe to drink.

The city of Cape Town has just dodged a bullet – at least for 2018. Day Zero -- the day when dams levels reach 13.5% of capacity and the taps are turned off – was originally expected to take place in April, then pushed back to July. Now it has been postponed to 2019. This video shows how Capetonians are dealing with the crisis.

The three-year long drought hasn’t ended but severe water rationing has helped postpone disaster. The combined levels of dams supplying Cape Town is down to 22.7%, according to the city’s water dashboard. Capetonians have been asked to limit their water use to 50 liters (13 gallons) per person per day, and many have risen to the occasion (as a point of comparison, the average U.S. resident uses 367 liters per day, or 100 gallons).

Unfortunately, Cape Town is not an anomaly: Fourteen of the world’s megacities now experience water scarcity or drought conditions, according to Ecolab’s Water Risk Monetizer. 

How can we reduce floods, droughts and water pollution? By using solutions already found in nature, things called “nature-based solutions,” like restoring forests and natural wetlands and reconnecting rivers to floodplains. That is why the theme of last week’s World Water Day was “Nature for Water,” an opportunity to explore using nature to overcome our challenges.

Under the Millennium Development Goals (MDGs), we did an excellent job of meeting half of Goal 7, Target 7.C: “Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.” The world met the safe water target. In fact, we did it five years ahead of schedule. Between 1990 and 2015, 2.6 billion people gained access to improved drinking water sources.

“The world did great with increasing access to improved water sources under the MDGs, and now needs to make sure that water is safe to drink at the point of consumption,” said Tim Neville, who is based in Zambia for Impact Water. “And the solution to that will inevitably involve a multisector approach – government, NGOs and the private sector.”

Earlier this month, the High-Level Panel on Water -- made up of 11 heads of state and a special advisor – released the report Making Every Drop Count that called for a fundamental shift in the way the world manages water. Maintaining the status quo, they found, will not get the job done. 

About 36% of the world’s population live in water-scarce regions where more than 20% of the global GDP is produced, the report says. By 2050, more than half of the world’s population -- and about half of global grain production – will be at risk due to water stress. Intense water scarcity may displace as many as 700 million people by 2030.

Technology will be important in solving this problem, but technical solutions alone will not be enough.  We will need integrated approaches addressing technical, institutional, financial, social and environmental issues. Addressing all of these areas simultaneously will require leadership well beyond the water community, and also require political leadership.

One very tangible thing we can do – less daunting than restoring forests and wetlands – is providing safe water, sanitation and hygiene(also called WASH) at health care facilities.

John Oldfield, principal of Global Water 2020, says lack of WASH in health care facilities is “sorely unrecognized, sorely uncovered in the media and sorely undercapitalized in human, technical and financial terms. It’s really serious and it’s really solvable.”

He said the problem applies to all types of health care facilities in low- and middle-income countries – public, private and faith-based. 

“Anytime a person gets sick at any level – from a huge urban government hospital down to a guy sitting under a baobab tree with a box of Band-Aids – every single one of those contexts requires access to safe drinking water, adequate sanitation facilities, hand-washing stations and waste management services. And very few of them do.” 

The latest reporting coming out of University of North Carolina’s Water Institute indicates that 50% of health care facilities in Bangladesh, Haiti, Malawi, Nepal, Senegal and Tanzania lack piped water, 33% lack improved toilets, 39% lack handwashing, and only 2% have access to those three things plus waste management services. 

U.N. Secretary-General António Guterres highlighted this issue at the launch of International Decade for Action on Water for Sustainable Development:

“I am using the launch of the Water Action Decade to make a global call to action for water, sanitation and hygiene in all health care facilities. A recent survey of 100,000 facilities found that more than half lack simple necessities, such as running water and soap - and they are supposed to be health care facilities.The result is more infections, prolonged hospital stays and sometimes death. We must work to prevent the spread of disease.Improved water, sanitation and hygiene in health facilities is critical to this effort.”
 

An important part of the solution proposed by the High-Level Panel is Universal Access to Safe Water and Sanitation. Over the last 20 years, some programs have implemented water treatment at the household or institutional level by promoting and distributing point-of-use treatment products. 

PSI has implemented point-of-use water treatment programs in its social marketing programs in Africa, Asia and Latin America since the late 1990s. It now has national scale water treatment programs in more than 30 countries, and markets liquid chlorine solution and Aquatabs water purification tablets. 

Impact Water,a social business, sells, installs and maintains water purification systems that use technologies like UV treatment, ultrafiltration and ceramic filters to schools in Kenya, Nigeria and Uganda. They have installed such systems in over 2,500 schools to date and plan to reach over 5,000 more in 2018 alone. 

Palladium manages social marketing programs in Mali, where it markets Aquatabs, and Zambia, where it distributes two brands of water purification solution, Klori-Safeand Klori-Pure. In 2017, Palladium sold over 7.5 million Aquatabs tablets in Mali, enough to purify 150 million liters of water.

These are only three examples of point-of-use water treatment. Taking safe water to the next level will require all of this and a whole lot more.

“To ensure water is microbiologically safe to drink, point-of-use treatment technologies need to be in place and this is a massive endeavor,” said Neville. “One way is to have more, low-cost, effective institutional and household technologies made available but unless they are user-friendly and often aspirational they won't yield sufficient uptake and consistent use.”