WHO Guidelines for Drinking-water QualityIceland, January 2005
Jamie BartramCoordinator
Water Sanitation and HealthWorld Health Organization
History of the Guidelines
1958, 1963, 1971: International Standards1984 First edition of “Guidelines”: basis for setting standards but standards responsibility of states1993 Second edition: increase in number of chemicals 2003 Third edition systematic safety approach; application to different settings.
WHO Water Guidelines
AimFeatures
Approach
Protection of human healthAdvisory in natureSupport national standard-setting adapted to social, cultural, economic & environmental contextRisk-benefit philosophyBest available evidence - science and practiceScientific consensusExploit global information and experience
Use of WHO Guidelines
Scientific basis for national and supra national norms and standards e.g. Japan, EU, Australia Active participant-users e.g. USA, CanadaTransposition e.g. some developing countries Used in absence of national standards/GL
Guidelines for Drinking-water Quality
ProcessPlan of work from IG meetings and proposalsIndividuals/teams draft documentsWorking groups initial review (and improvement)Public domain review (and improvement)“Final Task Force” meeting of government-nominated experts
Current Volumes of Guidelines for Drinking-water Quality
Volume 1: Summary
(series of monographs on individual chemicals and microbes)
Volume 3: Surveillance and control of community supplies
WHO Guidelines for Drinking-water Quality
Microbes (infectious agents)
Chemicals
Radiological aspects
Acceptability aspects
Application ‘settings’
Guidelines and Regulations for Water-borne Infectious Disease
• > 100 years “success” in outbreak control• reliance on end product testing: too little too late• post-exposure• residual disease burden• unrecognised pathogens• diverse health outcomes
WHO GDWQ 3rd Edition - Response
Moving away from reliance on output monitoring -measuring parameters in final waterMore input monitoring - measuring parameters that show that the system is workingShort-term quality changesCatchment-to-consumerNeeds transparency openness, inter-sectoralRisk-based
Buildings on multiple barrier, HACCP,….
Framework for Water Safety in3rd Edition WHO GDWQ
Health Based TargetsWater Safety Plans1 System Assessment2 Monitoring of control measures 3 Management PlansIndependent Surveillance
Health.-based targets(Chapter 3)
Water safety plans(Chapter 4)
Surveillance(Chapter 5)
Public health context and health outcome
System Monitoring
Management&
CommunicationMonitoring
Framework for Safe Drinking Water
Health-Based Targets
Targets based on public health protection and disease preventionBenchmark for water suppliesPublic health benefitLocal circumstancesQuantitative risk assessmentGuidance developed by WHOFrom simple to complex
WSP part 1: System Assessment
System assessment to determine whether the water supply chain (up to the point of consumption) as a whole can deliver water that meets the targets
Reality check before starting WSPSystem capability to meet Health-based TargetsOutcome identifies system improvementsValidation of processesIdentifying what reduces and prevents contamination
Health based targets
System assessment
Monitoring of control measures
Management Plans
Independent “surveillance”
WSP part 2: Monitoring of control measures
Monitoring of the control measures in the supply chain that are of particular importance in securing water safety
Target barriers identified in system assessmentOperational monitoring - continual effectivenessSimple parameters, from results to action
Health based targets
System assessment
Monitoring of control measures
Management Plans
Independant surveillance
WSP part 3: Management Plans
Management plans describing actions to be undertaken from normal conditions to extreme
events; including documentation and communication
Documented:system assessmentcontrol measure identificationmonitoring planmanagement responsessupporting programmes (SOPs, training …)communication plan
Health based targets
System assessment
Monitoring of control measures and actions
Management Plans
Independent “surveillance”
Independent Surveillance
Systematic independent surveillance that verifiesthat the above are operating properly
Audit of Water Safety Planshows WSP is being adhered to
Verificationend-product final check
Health based targets
System assessment
Monitoring of control measures and actions
Management Plans
Independent surveillance
Guidelines and Regulations for ChemicalsSuccesses and Challenges
very widely used monitoring against GVsscientifical basis clear and soundrefine approach and GVs as new evidence emergesvery many chemicalsrelative disease burden/severityconsistency of approach for ‘materials and chemicals ….’ (“additives”), up to tapshort-term versus long-term exposure
WHO GDWQ 3rd Edition - Response
Mainly “business as usual” - some new or modified GVsmore rigorous assessment of need for GVopportunity for wider commentgroup by source-type (management response)rolling revision and future strategy
Updating the Guidelines
Keeping the Guidelines up-to-date is a major challenge …WHO moving towards a ‘rolling revision’Substantiating the positions and ‘guidance’on good practice makes up most of the work. Recovery of field experience.Around 40 lines of work in the rolling revisionPeer and Public domain review have been ‘built-in’
Rolling Revision of WHO Guidelines for Drinking-water Quality
Application in specific settings
Small community water supplyWater and sanitation on ships and in aviation (linked to IHR)DesalinationTemporary water suppliesWater supply in emergenciesWater supply in large buildings, health care facilities
Origins of the Meeting
Guidelines Volume 3: 1st and 2nd editions
Guidelines 3rd edition, Water Safety Plans
Expression of concerns by countries about "small community" water supply safety
Icelandic and Australian leadership
Driving Forces & Issues
burden of disease, outbreaks and sporadic
80% of "unserved" are rural
water quality data few but show "small community" safety a priority
small/indigenous/peri-urban/remote
Outcomes – an action plan for an international initiative?
Might include:Network development
Develop a dedicated small system networkRegulators networkHousehold water safety network
Evidence base for advocacyBurden of diseaseCost and benefit analysisCountry situationsTechnology verification
Library of resource materials (eg capacity building)Development and dissemination of appropriate tools(physical, software)Lessons learned on organising support systemsOutreach e.g. to professional groups (IWA)Pilot application evaluation and reporting
Finding the Guidelines
Http://www.who.int/water_sanitation_health/GDWQ/index.htm