10th meeting of the WHO International Network of

Drinking-water Regulators (RegNet)

Geneva, Switzerland

27-29 November 2019

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Contents Summary and key outcomes ............................................................................................................ 1

Background ...................................................................................................................................... 3

Meeting proceedings ........................................................................................................................ 4

Session 1a: RegNet overview and update from Secretariat ................................................... 4

Session 1b: Updates from RegNet members .......................................................................... 5

Session 2a: Case study: Addressing fragmentation and gaps in regulation ........................... 6

Session 2b: Fragmentation and gaps in regulation and challenges in water quality

surveillance and water safety planning ........................................................................................ 7

Session 3: Learning exchange: Experiences and challenges in water reuse ............................ 8

Session 4: Emerging regulatory challenges ............................................................................. 9

Session 5: WHO update ......................................................................................................... 10

Session 6a: Managing chemical contaminants in drinking water ........................................ 12

Session 6b: Case study: Managing chemical contaminants in drinking-water .................... 12

Session 7: Operating and functioning of RegNet .................................................................. 15

Appendix 1: Meeting agenda ..................................................................................................... 17

Appendix 2: List of participants ................................................................................................. 22

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Abbreviations and acronyms

ADERASA Asociación de entes reguladores de agua potable y saneamiento de las Américas

CWSA Community Water Supply Agency

DWI Drinking Water Inspectorate

ENDWARE European Network of Water Regulators

ERSAR Entidade Reguladora dos Serviços de Águas e Resíduos

ESAWAS Eastern and Southern Africa Water and Sanitation Regulators Association

EU European Union

FAO Food and Agriculture Organization

GDWQ WHO Guidelines for Drinking-water Quality

GLAAS UN-Water Global Analysis and Assessment of Sanitation and Drinking-water

HRWS Human Right to Water and Sanitation

INFOSAN International Food Safety Authorities Network

JMP WHO/UNICEF Joint Monitoring Programme on Water Supply, Sanitation and

Hygiene

NWASCO National Water Supply and Sanitation Council

PURC Public Utilities Regulatory Commission

RegNet WHO International Network of Drinking-water Regulators

SDGs Sustainable Development Goals

UNICEF United Nations Children’s Fund

WASH water, sanitation and hygiene

WHO World Health Organization

WSRC Water Services Regulatory Commission

WSP Water Safety Plan

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Summary and key outcomes

The 10th meeting of the World Health Organization (WHO) International Network of Drinking-

water Regulators (RegNet) was held on 27-29 November 2019, at the WHO headquarters in

Geneva, Switzerland. The overall objectives of the meeting were to share experience and best

practice in addressing gaps in regulation; managing chemical contaminants; and various

emerging regulatory challenges. This report summarizes the discussions and main outcomes from

the meeting.

Key discussion topics

The key discussions and recommendations / follow-up actions are outlined below:

• Regional regulators’ networks: Several RegNet members shared updates from regional

regulators’ networks in eastern and southern Africa, Europe and Latin America. Among the

main updates were the regional networks’ strategic focus on: climate resilient water supply

and sanitation services; regulation of on-site sanitation services; human right to water and

sanitation; micropollutants; and links between climate change, warmer water temperatures and

legionella.

• Improving public health communication: There is a lot a of media and public attention on

emerging pollutants such as microplastics, glyphosate, etc. Improving communication

strategies on these emerging pollutants is an increasing priority, and in particular, articulating

what is a public concern versus public health issue to avoid public panic. WHO’s report on

Microplastics in drinking-water was published in 2019, and Canada is working on a

microplastics report that is to be published in March 2020. As follow up, Yasir Sultan will

share the report on microplastics in drinking-water in Canada with RegNet.

• Addressing gaps in regulation: A case study of drinking-water regulation in Ghana

highlighted overlapping mandates in regulation of water supplies in urban areas and gaps in

regulation of tanker supplies and rural water supplies. As a result of these gaps, audit of water

safety plans (WSPs) and water quality surveillance for non-piped are weak. Input from

participants on how to address these challenges emphasized the need for political will from the

government to reform the sector, and a systematic and wholistic reform process that involves

at all key stakeholders. Discussions also highlighted that while the promulgation of a water

service act would not solve all the regulatory challenges, it would help in organizing the sector

by defining roles and mandates of stakeholders involved. As follow up:

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o The Eastern and Southern African Water and Sanitation (ESAWAS) Regulators

Association could visit Ghana to conduct a peer review of the water sector and regulatory

landscape in the country

o Entidade Reguladora dos Serviços de Águas e Resíduos (ERSAR) in Portugal and Water

Services Regulatory Commission (WSRC) in the occupied Palestinian Territories will

continue to provide peer support in strengthening regulation of WSPs to Ghana

o WHO will share a summary of a RegNet discussion thread on regulating tanker supplies

o WHO will share the survey questionnaire for the Global Analysis and Assessment of

Sanitation and Drinking-water (GLAAS) for review by RegNet members ahead of the next

data collection cycle.

• Water quality monitoring for small systems / point sources: Members shared some of the

challenges related to water quality monitoring and small systems, as well as solutions that they

have implemented. The revision of the WHO guidelines for small water supplies is underway,

and the experiences shared would be useful to informing this revision.

• Regulating water reuse: Among the main challenges cited with regulating water reuse are

addressing public perception of potable reuse, and the complexities of engaging with a diverse

range of stakeholders. It was agreed that a practical guidance document on developing

wastewater regulations analogous to the Developing drinking-water quality regulations would

be useful.

o As follow up, WHO will share an outline of the proposed scope of the document for

feedback from RegNet, and seek potential reviewers of the draft document.

• Quality of service standards: Several members have introduced / updated standards for quality

of service. Members outlined standards for water pressure, continuity and approaches for

metering.

o As follow up, RegNet members will share their quality of service standards via email.

• RegNet engagement with review processes of the WHO Guidelines for Drinking-water Quality

(GDWQ): A number of chemical contaminants are under review as part of the development of

the second addendum to the fourth edition of the GDWQ. Discussions highlighted the need to

more systematically obtain feedback from regulators in preparation of background documents,

particularly on practical aspects and application of guideline values.

• Managing lead contamination in drinking-water: Invited participants from the Water Institute

at the University of North Carolina and World Vision International presented a case study of

lead contamination in water systems in Ghana, Mali and Niger. A positive relationship

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between copper and lead in the samples analyzed suggests that the lead contamination is due

to corrosion of brass components. As follow up:

o WHO, in liaison with members of the Expert Advisory Group to the GDWQ (David

Cunliffe and John Fawell) will draft a briefing note on actions to be taken. These could

include, as an initial step, replacing the foot valves in the water systems that had higher

lead concentrations with those that have lower lead composition and evaluate whether this

leads to a reduction in the concentrations detected in water.

o RegNet members will contribute to the aforementioned briefing note with case studies of

how they have managed lead contamination in their own contexts.

• Operation and functioning of RegNet: There were mixed views on whether the scope of

RegNet should be limited to drinking-water quality only, or include quality of service,

wastewater and economic regulation. Discussions also highlighted the need to improve the

communications and provide a platform for easier sharing of documents / serve as a repository.

As follow up:

o WHO will draft updated terms of reference for the network for input from RegNet

o WHO will explore options for improving the communications platform of the network.

Background

RegNet was established in 2008 as a platform to share experiences and to promote best practice

relating to the regulation of drinking-water quality. The network aims to promote public health

protection by increasing access to safe drinking water through the continual improvement of

regulatory systems1. The Water, Sanitation, Hygiene and Health unit at the WHO headquarters

acts as Secretariat to RegNet and coordinates network activities.

The 10th meeting of the network was attended by approximately 30 participants including

members of RegNet, and invited participants from the governments of Ghana and Niger, the

United Nations Children’s Fund (UNICEF), the Water Institute at the University of North

Carolina, the World Plumbing Council, World Vision International and members of the expert

advisory group to the WHO Guidelines for Drinking-water Quality.

The objectives of the meeting were to:

1. Discuss emerging regulatory challenges among members.

2. Share experience and best practice in:

a. addressing gaps and fragmentation in drinking water regulations; and

1 For further information regarding the specific goals and objectives of RegNet, as well as information pertaining to eligibility for membership, please refer to http://www.who.int/water_sanitation_health/dwq/TORRegNet.pdf?ua=1.

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b. managing chemical contaminants in drinking water

3. Review challenges and successes in water safety planning and water quality surveillance; and

4. Update on key WHO activities related to regulation of drinking water and waste water services.

The meeting agenda is attached in Appendix 1, and the list of participants in Appendix 2.

Meeting proceedings

The meeting was opened by Bruce Gordon (WHO), who welcomed participants and emphasized

WHO’s commitment to working with regulators to support the development and implementation

of drinking-water quality regulations to promote public health protection. Participants then

introduced themselves and outlined expectations from the meeting. Addressing fragmentation in

regulation; regulating water reuse and managing chemical contaminants were among the

expectations from the meeting. The proceedings of the various meeting sessions are outlined

below.

Session 1a: RegNet overview and update from Secretariat

Session 1a was an update on the network, including main discussion points and outcomes from

the 2017 meeting, new members, and recent publications that RegNet members contributed to.

Discussions at the 2017 meeting focused on the role of regulators in supporting achievement of

the Sustainable Development Goals (SDGs) related to water and sanitation; progressive

improvement in regulation, including targeted input to invited participants from Ethiopia and

Liberia on developing drinking-water regulations, and expanding the scope of RegNet to include

wastewater/onsite sanitation2.

New RegNet members include representatives from Health Canada; the Public Utilities

Regulatory Commission (PURC) in Ghana; Environmental Protection Agency in Ireland,

Ministry of Health in Malaysia; Water Services Regulatory Commission (WSRC) in the occupied

Palestinian Territories; and the Department of Energy in Abu Dhabi, United Arab Emirates.

Regarding publications:

• the Global overview of national regulations and standards for drinking-water quality

(‘RegScan’) was published in 2018 and has attracted a lot of interest. It summarizes

information from 104 countries and territories on values specified in national drinking-water

quality standards for aesthetic, chemical, microbiological and radiological parameters. The

2 The 2017 meeting report is available at: https://www.who.int/water_sanitation_health/water-quality/regulation/regnet_reports/en/

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document is currently being updated to include information from additional countries, and the

updated version should be published in Q1 of 2020.

• The Developing drinking-water quality regulations and standards was published in 2018. It

provides practical guidance to support development/revision of customized national or

subnational drinking-water quality regulations and standards. The document includes

supporting examples from both lower- and higher-income countries.

Session 1b: Updates from RegNet members

Session 1b presented brief updates from regional networks of regulators, including recent

activities.

Eastern and Southern Africa Water and Sanitation (ESAWAS) Regulators Association

Peter Mutale gave an brief update on ESAWAS, whose objectives are to foster good practice and

enhance capacity in water supply and sanitation regulation3. As part of its 2019-2021 strategic

plan, the association is developing a common regulatory framework for onsite sanitation systems,

and developing a strategy to address non-revenue water (NRW) by documenting case studies of

bad and good practice in its management. In addition, ESAWAS is collaborating with the Climate

Resilience Infrastructure Development Facility to develop risk assessment and adaptation

measures for climate resilient water supply and sanitation services.

European Network of Drinking-water Regulators (ENDWARE)

Susana Rodrigues shared an overview of ENDWARE, an informal network of European

drinking-water regulators which provides a confidential space to discuss drinking-water issues

and share experience in implementing drinking-water guidelines. Current discussions in

ENDWARE include the recast of the European Drinking Water Directive; climate change and

increases in legionella cases due to increased temperatures of water in pipes; as well as

perfluoroalkylated substances (PFAS) and persistent, mobile and toxic substances (PMT) in water.

Under discussion is how to communicate with the public on topical issues that are of public

concern (e.g. microplastics), and distinguishing these from public health issues.

Asociación de entes reguladores de agua potable y saneamiento de las Américas (ADERASA)

Oscar Pintos presented an update from ADERASA, whose objectives are to facilitate the

exchange of good practice and training of technical staff in the Latin American and Caribbean

region4. Among the network’s current activities is a report on affordability of water and

3 More information on ESAWAS can be found on: http://www.esawas.org/ 4 More information on ADERASA can be found here: http://www.aderasa.org/v1/

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sanitation services in the region. Alejo Molinari from Ente Regulador de Agua y Saneamiento

(ERAS) shared an update on the region’s work on assessing implementation of the Human Right

to Water and Sanitation (HRWS). Work is underway for regulation benchmarking to support

HRWS, and the regional network is also working to include climate change considerations in

regulatory frameworks.

Session 2a: Case study: Addressing fragmentation and gaps in regulation

Session 2a was a case study from Ghana aimed at sharing experience and best practice in

addressing fragmentation in drinking-water regulation

Suzzy Abaidoo from the Ministry of Sanitation & Water Resources and Millicent Mensah form

the Public Utilities Regulatory Commission (PURC) in Ghana gave an outline of the drinking-

water regulatory landscape in the country. The presentation highlighted overlapping mandates

and gaps in regulation of water supplies that had been identified through previous stakeholder

engagement fora, and more recently, during the 2018 UN-Water Global Analysis and Assessment

of Sanitation and Drinking-water (GLAAS) survey. Both PURC and the Food & Drugs Authority

(FDA) are mandated to regulate water supplies in urban areas, and there is seemingly no agency

mandated to regulate rural water supplies and other non-piped supplies, including tanker trucks

and boreholes. As a result, auditing of water safety plans (WSPs) and water quality surveillance

are for non-piped supplies is weak.

To date, Ghana has requested support from RegNet (through WHO) in strengthening capacity in

WSP auditing. ERSAR in Portugal and WSRC in the occupied Palestinian Territories have

agreed to mentor a local university, Kwame Nkrumah University of Technology (KNUST) in

developing training modules on WSP auditing.

Recommendations / follow up ensuing from the session were:

• Institute a comprehensive sector reform process: Peter Mutale from the National Water

Supply and Sanitation Council (NWASCO) in Zambia shared experience in the water and

sanitation sector reform that led to the establishment of NWASCO. The comprehensive review

that was conducted as part of this reform had been useful in identifying players in the sector,

understanding their roles and identifying the gaps to be addressed. ESAWAS conducts similar

peer-reviews of its members, and as representative of the association, Peter that ESAWAS

conduct a peer review visit to Ghana.

• Consider promulgating a Water Services Act: Input from members highlighted that while a

Water Services Act is not a silver bullet, it would help in outlining roles of the various actors

involved.

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Discussions noted that twinning arrangements could be useful in addressing the aforementioned

and other regulatory challenges, with ERSAR outlining how they have used twinning

arrangements to strengthen regulation in Portuguese-speaking countries, and similar

arrangements exist between members of ADERASA. However, there was general consensus that

depending on the matter to be addressed, twinning has greater impact when it is between

countries in the same region.

Fiona Gore (WHO) presented an overview of GLAAS, including key findings from the 2019

report. These include: wide gaps between frameworks and practice, i.e. surveillance mandates are

defined but implementation is weak; there is a need to focus on meaningful use of data to effect

change: data is collected but not used for remedial action. In addition, inadequate funding and

staffing are major challenges that are limiting implementation of drinking water quality

surveillance activities in many countries. Discussions focused on how TrackFin (a component of

GLAAS which surveys national WASH sector financing) could be embedded in national systems;

dissemination of the GLAAS report to policymakers; and feedback on the regulation-related

questions in the GLAAS questionnaire. As follow up, WHO will share the GLAAS questionnaire

for review by RegNet members.

Session 2b: Fragmentation and gaps in regulation and challenges in water quality

surveillance and water safety planning

Session 2b built on the previous session, and shared experience and practice in addressing

members questions related to water quality monitoring, WSPs and small systems.

Challenges in water quality monitoring for small systems and point sources. Among the main

challenges in water quality monitoring for small systems are urban migration which leads to

attrition of trained staff; and the expense of transporting samples to laboratories for analysis. For

point sources in particular such as handpumps, there is a lot of information on functionality etc.

drawn from water point mapping, but no data on water quality. Members shared some of the

actions they have taken to address these challenges, which include:

• Using semi-quantitative portable test kits on site, and if positive, sending the samples to

laboratories for further analyses;

• Engaging local environmental health practitioners in water quality monitoring;

• Conducting sanitary inspections for point sources;

• Certifying laboratories that are closer to sampling locations; and

• Using public transport to transport samples to laboratories for analyses

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An additional challenge cited is implementing WSPs in small systems. Members shared that they

have gone around this problem by starting off with voluntary implementation, and using the

successes from these volunteer small systems to encourage others. The WHO Guidelines for

Small Water Supplies are currently being revised. Many of the challenges and solutions cited

would be informative to the revision.

Increasing political will for regulation. Advocating for better resourcing for the water and

sanitation sector and strengthening regulation was cited as a challenge in the occupied Palestinian

Territories. Peter Mutale shared that in Zambia, NWASCO regularly meets with parliament as

part of its communication strategy, giving an opportunity to address / clarify issues and in this

way, have political buy-in. Alejo Molinari (ERAS) suggested approaching the issue through a

health economics lens to illustrate the savings that can be made from improved water quality.

Session 3: Learning exchange: Experiences and challenges in water reuse

Session 3 focused on members’ experiences and challenges in regulating water reuse, and

presented overviews of WHO guidance on potable reuse and wastewater reuse for irrigation

Potable reuse

Lucia Bonnadonna (Ministry of Health, Italy) outlined how water reuse is an increasing priority

in the country, due to climate change and challenges with water availability. Only one region has

regulations for wastewater reuse for irrigation, and direct potable reuse is forbidden. Desalination

covers about 0.5% of water intended for human consumption on small islands and central and

southern Italy. The country is developing national guidelines on risk management / WSPs for

desalination plants.

Bruce Gordon (WHO) outlined the scope of the WHO document Potable Reuse: Guidance on

producing safe drinking-water. Only one country in the world (Namibia) currently practices

direct potable reuse. Barriers to implementing direct potable reuse cited include the possibility of

ineffective treatment in the case power outages or chemical spills, and public perception

(including religious concerns) of direct potable reuse.

Wastewater reuse

Kate Medlicott (WHO) presented an overview of the WHO Guidelines for Safe Use of

Wastewater, Excreta and Greywater, including linkages with sanitation safety planning. Peter

Mutale (NWASCO) shared that Zambia is developing regulations for wastewater reuse for

agriculture. Discussions focused on challenges and experiences in regulating wastewater reuse.

Among the challenges cited were: balancing behavioural and technical issues related to

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wastewater reuse; and having to engage with multiple actors (more than in the drinking-water

sector), exacerbated by unclear mandates e.g. Mohammad Al Hmaidi (WSRC) shared that in the

occupied Palestinian Territories it is not clear who sets tariffs and monitors wastewater quality.

There was consensus that greater coordination is required between drinking-water and

wastewater sectors in order to have effective wastewater regulation. As follow up, there was

interest in having WHO develop guidance on how to develop wastewater regulations, possibly

analogous to the Developing drinking-water quality regulations and standards.

Session 4: Emerging regulatory challenges

Session 4 was an overview of drinking-water regulation in Switzerland, and a roundtable

discussion of various regulatory challenges that members are facing.

Drinking-water regulation in Switzerland

Pierre Studer (Federal Food Safety and Veterinary Office, Switzerland) presented an overview of

drinking-water regulation in Switzerland. WSPs have been implemented since 2005, with risk-

based surveillance in place. There are proposed guidelines for WSP implementation in small

systems, which have currently been self-regulated by suppliers. Among the regulatory challenges

are micropollutants such as pesticides and antibiotics, as well as legionella: cases have been

rising since 2000, and it is not clear what the underlying cause is.

Water pressure

Alejo Molinari (Ente Regulador de Agua y Saneamiento, Argentina) outlined pressure

requirements that have been set in Buenos Aires. To ensure sufficient pressure, buildings taller

than two stories should have an underground reservoir and their own pumps. Utilities are

responsible for water quality up to the meter. Thereafter, it is the responsibility of the building

owners to ensure the quality of the water, and there is a municipal regulation requiring building

owners to clean their reservoir twice per year, regardless of size. This is being reviewed, as the

argument has been that the water delivered has enough residual chlorine so cleaning could be less

frequent.

Related discussions were on how to deal with households adding their own pumps to boost water

pressure, as this exacerbates low pressure and leads to lower water consumption for surrounding

households. This led to a discussion on metering approaches, as in communal buildings where

there is only a single meter, the billing is not reflective of actual consumption for those

households with low water pressure. Khadija Hasan Bin Braik (Department of Energy, Dubai)

shared that to address this problem, a guard meter is installed for the whole building, in addition

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to individual household meters. The difference between these meter readings is paid for by the

building administrator. Laura Moss from the Drinking Water Inspectorate (DWI) shared that in

the United Kingdom, metering is based on the size of the property.

Continuity of service

Rachid Wahabi (Ministry of Health, Morocco) outlined the new continuity of service

requirements that have been introduced in the national drinking-water regulations. Regulators

outlined the various metrics they are using for continuity of service, which include:

• Number of water cuts for which consumers do not have advanced notice;

• Duration of time that people do not have water during the year, and the number of people

affected; and

• per capita water consumption, as a proxy indicator

There was some discussion and debate as to the usefulness of per capita water consumption proxy,

and the extent to which it reflects continuity of service.

Defining an ideal utility

Mohammad Al Hmaidi (WSRC) raised the question of what is an ideal utility, from a regulator’s

perspective. Through an interactive online poll, members stated the three things that came to

mind when they thought of an “ideal” utility: one that plans ahead, is sustainable, and adheres to

a high quality of work. Additional comments from Pranav Joshi (Singapore Food Agency) and

Alejo Molinari (ERAS) emphasised that a utility should also be ideal from the perspective of the

consumer, and the importance of progressive improvements in utilities – there are no miracles.

Discussions led to benchmarking, and how this may help utilities to improve. Other comments

noted that while it can be used to learn best practice and improve, it should be kept as simple as

possible, with fewer indicators giving a clearer picture.

Members are agreed to continue the discussion on quality of service parameters by sharing their

standards via email.

Session 5: WHO update

Session 5 presented updates on key WHO activities related to water quality management

Updates on recent WHO activities and publications

Bruce Gordon (WHO) presented an overview of the WHO report on Microplastics in drinking-

water, and outlined the key messages from the report. The lack of standardized monitoring

approaches impacts on the data on occurrence of microplastics. Yasir Sultan shared that Health

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Canada will be publishing a report a microplastics, including their presence in bottled water, in

March 2020. Lucia Bonnadonna (Ministry of Health, Italy) outlined that microplastics have been

proposed under the recast of the EU Drinking Water Directive and wastewater revisions, but

Member States disagree as there are no standard analytical methods, and propose to put the topic

on a watch list instead.

Rick Johnston (WHO) updated on the status of global monitoring of water, sanitation and

hygiene services under the WHO/UNICEF Joint Monitoring Programme for Water Supply,

Sanitation and Hygiene (JMP). Regulatory data on indicators such as water quality, continuity of

supply, faecal sludge management have been useful in developing national estimates on safely

managed drinking-water and sanitation services in households, healthcare facilities and schools.

Batsi Majuru (WHO) outlined the objectives of the WHO International Scheme to Evaluate

Household Water Treatment Technologies, and presented results of the 30 products that have

been evaluated to date. The results of the Scheme are intended to guide procuring UN agencies

and governments in product selection.

Emerging low-cost assays for faecal contamination

Esther Shaylor (UNICEF) presented an overview of a target product profile that is being

developed for low-cost faecal contamination assays. Potential use cases for these assays include

water quality surveys (e.g. as part of the SDG monitoring by JMP); community-led monitoring /

emergency response; and regulatory and surveillance testing. The three emerging approaches are

based on nucleic acids, tryptophan and biosensors. WHO is developing a protocol to validate the

performance of the emerging faecal contamination assays against a reference method (membrane

filtration), similar to the aforementioned evaluation scheme for point-of-use / household water

treatment technologies.

As part of the discussion, members were asked: what technology they currently use for water

quality testing; barriers preventing them from doing more water quality testing; and what

evidence they would need to adopt new water quality assays. Most members indicated that they

currently use culture-based methods, thus requiring laboratory facilities. This is challenging when

testing for small water supplies, due to the need to transport samples. One of the barriers to

conducting more water quality testing is the bacteriological analysis: processing the media,

waiting for results etc. is tedious. In order to adopt new water quality assays, they would need to

compare results with those from the methods they are using. If the same results can be obtained

faster and at low cost, the assay could be adopted. Other members indicated that a rapid

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presence/absence assay would be useful, as there would be follow up based on detection of faecal

contamination alone, so a quantitative assay is not critical.

Session 6a: Managing chemical contaminants in drinking water

Session 6a was focused on member challenges related to the management of chemical

contaminants in drinking-water.

Fluoride

Roundtable discussions on the management of fluoride highlighted the following:

• Kenya is in the fluoride belt, and many water sources have high levels of fluoride. With SDG

monitoring now including fluoride as a priority contaminant, these fluoride levels will likely

impact the estimate for safely managed drinking-water. There are currently limited options for

large scale removal, as most are household-level / point-of-use treatment technologies

• In Argentina, the fluoride problem is two-fold: naturally occurring fluoride in some

groundwater sources, and fluoridation of surface water by utilities. There is an ongoing public

debate on whether the latter should be discontinued

• In Ghana, the main challenge with fluoride is in small systems and point sources, as treating

for fluoride in these contexts is expensive. When the sources are decommissioned due to high

fluoride levels there is public pressure to reopen them. As fluoride cannot be tasted it is

difficult to communicate the safety concerns to communities, or obtain agreement to

decommission the sources.

Arsenic

• Arsenic is a problem in Argentina. While there is a provisory limit for arsenic of 10 ppb, Alejo

Molinari (ERAS) was interested in finding out whether there is new evidence for a revised

limit.

• In the Philippines the limit is 0.1 ppm. While there have been cases of arsenicosis, a concern

has been that shutting down the utilities would be more of a public health risk.

Session 6b: Case study: Managing chemical contaminants in drinking-water

Session 6b was a case study of lead contamination in water supplies in three countries, and

aimed to characterize the extent of the problem, and share experience in managing and

communicating the issue.

The Water Institute at the University of North Carolina (UNC) conducted an evaluation of World

Vision International’s projects in Ghana, Mali and Niger. Water quality surveys conducted as part

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of the evaluation detected lead in over 50% of 261 water systems across the three countries. In

the water systems where lead was detected, 5-10% of samples exceed the WHO provisional

guideline value of 0.01 mg/L5. Positive correlations between copper and lead within the samples

analysed suggest corrosion of brass components of the water systems as a significant source of

the lead contamination. A journal manuscript reporting on these findings is forthcoming. Samuel

Diarra (World Vision International) also presented some findings on lead contamination in other

sites in Ghana, Mali and Niger that showed >10 µg/L at the time of drilling and installation of

boreholes. Follow up surveys showed decrease in the lead concentrations.

Country responses

Government representatives from two of the countries included in the survey were present at the

meeting, and shared the governments’ responses to the survey results. Worlanyo Siabi from the

Community Water Supply Agency (CWSA) and Suzzy Abaidoo from the Ministry of Sanitation

& Water Resources, Ghana outlined that responses to date include:

• addressing supply chains through dialogue with pump manufacturers regarding lead levels in

the pump components;

• reviewing standards for materials in contact with drinking-water, led by the Ghana Standards

Authority;

• initiating a process to identify a regulatory authority that would be responsible for overseeing

standards for materials in drinking-water; and

• improving surveillance by including lead and arsenic in routine water quality monitoring. The

latter has been challenging, due to limited laboratory capacity for trace metal analyses in many

of the rural districts. This has however led to more dialogue with the government on the need

to strengthen laboratory capacities.

Moussa Maman from the Ministry of Water and Sanitation, Niger outlined that there had been a

workshop with all countries involved in the survey, from which a report and recommendations

had been developed. This report was disseminated amongst service providers, technicians and

non-governmental organizations in the country. However, there is an equally pressing problem

with fluoride, which has affected 4 000 people in one city. As part of the response to the lead

findings, a survey was conducted to verify the results, and households with plumbing have been

advised to do a first flush of water before use.

5 The guideline value is provisional on the basis of treatment performance and analytical achievability. Concentrations should be maintained as low as reasonably practical. See: Guidelines for Drinking-water Quality: Fourth edition incorporating first addendum, 2017. Geneva: World Health Organization (https://www.who.int/water_sanitation_health/publications/drinking-water-quality-guidelines-4-including-1st-addendum/en/)

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How serious is the problem?

Members of the expert of the advisory group to the GDWQ John Fawell and David Cunliffe

emphasized that there is no need for panic, and emphasized three points: (i) the study indicates

that water systems components are a significant source of lead contamination, so the source of

contamination is known; (ii) the health risk is relatively low: detected concentrations are unlikely

to be discernible in blood levels; and (iii) going forward, the health risk can be lowered even

further.

Member experiences

• In Argentina, regulators are responsible for water quality up to the property line. As most lead

is in the household connections, regulators are not involved in managing the lead

contamination;

• In Canada, corrosion control materials are added to water. A revision in the maximum

allowable lead concentration from 10 ppm to 5ppm led to a significant increase in exceedances.

Among the main lessons learned was the need to have a strong communications plan for both

utilities and households;

• In Morocco, the Ministry of Health is responsible for overseeing the quality of water up to the

point of use. There were problems with lead in water 20 years ago, and the government

decided to replace all pipes containing lead. To date, about 50% of the pipes have been

replaced, and regulations for materials in contact with water have been implemented;

• In the occupied Palestinian Territories, government subsidies have been offered to households

wishing to replace lead fittings. Source protection measures such as banning dumping of

batteries near water sources and battery recycling have also been implemented;

• In the United Kingdom, most utilities add polyphosphates for corrosion control. However, this

means that the wastewater utilities have to treat these phosphates. There is a plumber

certification/approval scheme, under which a plumber would be required use approved

components with low lead, but it is voluntary. There have been 60 reported incidences with

faulty toilet installations that have resulted in back-siphoning into the drinking-water supply;

and

• In Zambia, lead mining in some parts of the country has led to high lead concentrations in soil.

No health impact studies have been conducted.

Discussions also noted that in old buildings in which several plumbing modifications may have

been made over time, it is difficult to locate the lead fittings. Point-of-use filtration devices and

flushing recommendations may be the most feasible options.

15

Certification

Paul Bonsak (World Plumbing Council) presented an overview of the impact of non-compliant

plumbing and construction products, highlighting the importance of product certification. The

certification entails product review and certification of compliance with safety standards;

certification schemes of plumbers/installers; plumbing codes and standards; and manufacturer

audit to ensure compliance.

Discussions highlighted that the costs of such certification may be prohibitive in resource-limited

settings: it costs approximately $3 200 to process an application; $8 000-16 000 to test for lead in

components; and there is an ongoing annual audit fee of $3 000. In Niger, handpump components

are being source from a range of countries where there are no clear standards, and good quality

components with low amounts of lead are expensive.

Key recommendations and next steps:

• Have a clear communication plan that outlines the problem and short- and medium-term

measures to manage it, and is tailored to various target audiences;

• Pilot replacement of components in water systems that have higher lead concentrations, and

scale up if it helps address the problem. As the footvalves are thought to be the main

contributing component, this would mean replacing them with valves containing less lead and

monitoring to see if this addresses the problem. Similar progressive approaches have been

implemented in many settings including Europe, where the guideline values for lead were

progressively decreased from 25 µg/L to 10 µ/L; and

• Progressively address materials in contact with drinking-water, through implementation of

standards for these materials.

John Fawell and David Cunliffe noted that as a number of the RegNet members have had to

manage lead contamination in water, it would be useful to compile the various approaches as case

studies in a briefing note

Session 7: Operating and functioning of RegNet

Session 7 was reviewed how the operation and functioning of RegNet could be improved, and

what lessons could be learned from other networks

Lessons learned from INFOSAN

Peter Ben-Embarek (WHO) shared lessons from the International Food Authorities Network

(INFOSAN). The network is co-hosted by WHO and the Food & Agriculture Organization

(FAO). The objective is to disseminate food safety information to members during emergency

16

situations, and provide a platform to discuss topical food safety issues with experts from around

the globe. The network was set up in 2012 and now has over 600 network members in 180

countries. Among the lessons learned is the need to engage members on topics that are useful to

them, including engaging in different languages. Regional meetings have also enabled stronger

member engagement, as well as high level resolutions from the World Health Assembly, and

CODEX and EU resolutions that have encouraged countries to join the network.

Future directions and follow up actions

The meeting concluded with RegNet members reflecting on the future scope of the network and

the role that the regulators should have in relation to various WHO guidelines. The key

discussion points were:

• bridging the gap between science and practice is important, and RegNet should be involved in

the review of water quality guidelines in a more systematic way;

• the case studies presented in some of the meeting sessions were appreciated: members

indicated that such a format helped them learn a lot;

• membership of the network was key for some regulators to incorporate WSPs into their

drinking water quality regulations, and was highlighted as one of the successes of the network;

• future directions could include how to regulate for the most vulnerable, in line with SDG 6

principles on leaving noone behind; and

• in addition to drinking-water quality, there is appreciation for discussions on other areas of

regulation including quality of service, wastewater/sanitation and economic regulation.

Discussions on whether the scope should be on drinking-water primarily or encompass these

additional areas were mixed.

In terms of the operations of RegNet, the WHO Secretariat will work on improving

communications, including exploring the possibility of having the communications platform

hosted by INFOSAN; and draft a briefing note on how RegNet can move forward.

17

Appendix 1: Meeting agenda

Wednesday 27 November 08:30 – 09:00 Arrival and registration of participants 09:00 – 09:30 Opening session

Chair: Bruce Gordon ¦ WHO Opening remarks

Review of agenda, plans for rapporteuring Introductions

Bruce Gordon ¦ WHO

09:30 – 10:30 Session 1a. RegNet overview and update from Secretariat Objective: recap on the vision of RegNet; update on activities since the previous meeting Chair: Bruce Gordon ¦ WHO

Overview of RegNet (vision and expectations) Network update and recap of 2017 meeting

Bruce Gordon ¦ WHO Batsi Majuru ¦ WHO

10:30 – 10:45 Coffee/ tea break 10:45 – 11:45 Session 1b. Updates from RegNet members

Objective: share updates on priorities & progress from regional networks of regulators Chair: Bruce Gordon ¦ WHO

10:45 – 11:45 Updates from regional regulators’ networks: ̶ Eastern and Southern Africa Water and Sanitation

(ESAWAS) Regulators Association ̶ European Network of Drinking Water Regulators

(ENDWARE) ̶ Asociacion de Entes Reguladores de Agua y Saneamiento

de Las Americas (ADERASA) (general update + role of regulators in supporting the Human Right to Water)

Peter Mutale ¦ NWASCO, Zambia Susana Rodrigues ¦ ERSAR, Portugal Oscar Pintos ¦ ENRESS, Argentina / Alejo Molinari ¦ ERAS, Argentina

11:45 – 12:30 Session 2a. Case study: Addressing fragmentation and gaps in regulation Objective: share experience and best practice in addressing fragmentation in drinking-water regulation; facilitate peer support of review of national water policies Chair: Bruce Gordon ¦ WHO

11:45 – 12:30 Regulatory landscape in Ghana, including role of PURC Suzzy Abaidoo ¦ Ministry of Sanitation & Water Resources / Millicent Mensah ¦ PURC, Ghana

12:30 – 13:30 Lunch 13:30 – 15:00 Session 2a. Case study continued: Addressing fragmentation and gaps in regulation

Objective: share experience and best practice in addressing fragmentation in drinking-water regulation; facilitate peer support of review of national water policies Chair: Laura Moss ¦ United Kingdom

13:30 – 14:10 Discussion / input from members How have other countries handled gaps / fragmentation in drinking-water regulation?

14:10 – 15:00 Assessing WASH systems: overview of GLAAS and links to regulation Lessons from WSPs + status of surveillance

Fiona Gore ¦ WHO Bruce Gordon ¦ WHO

15:00 – 15:15 Coffee/ tea break 15:15 – 17:05 Session 2b. Fragmentation and gaps in regulation and challenges in water quality

surveillance and water safety planning Objective(s): discuss implications of fragmented regulatory landscape on water quality surveillance + WSPs and how to address challenges Chair: Laura Moss ¦ United Kingdom

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15:15 – 15:45 Discussion: What are concrete opportunities to increase political will to address resource gaps?

Roundtable

15:45 – 17:00 Related member questions 17:00 – 17:05 Wrap up Batsi Majuru ¦ WHO

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Thursday 28 November 09:00 – 09:10 Reflections from Day 1 Rachid Wahabi ¦ Ministry of

Health, Morocco 09:10 – 10:30 Session 3. Learning exchange: Experiences and challenges in water reuse

Objectives: (i) share experience and challenges in regulating water reuse; (ii) present overview of WHO guidelines on potable reuse and safe use of wastewater and seek feedback on feasibility / challenges and successes in implementing guidelines Chair: Pierre Studer

09:10 – 09:20 Experiences and regulatory challenges in potable reuse of water

Lucia Bonnadonna ¦ Ministry of Health, Italy

09:20 – 09:50 Overview of WHO guidelines on potable reuse of water Bruce Gordon ¦ WHO 09:50 – 10:30 Related member question(s)

Overview of WHO Guidelines for Safe Use of Wastewater Kate Medlicott ¦ WHO

10:30 – 10:45 Coffee / tea break 10:45 – 12:30 Session 4: Emerging regulatory challenges

Objectives: Share experience and best in addressing emerging regulatory challenges among RegNet members Chair: Pierre Studer

10:45 – 11:50 Drinking-water regulation in Switzerland Member challenges

Pierre Studer ¦ FDHA, Switzerland Roundtable

11:50 – 12:30 Panel discussion: Defining an ‘ideal utility’ from regulators perspectives

Panellists: Pranav Joshi, Singapore Food Agency Alejo Molinari, ERAS

12:30 – 13:30 Lunch 13:30– 15:00 Session 5. WHO update

Objectives: Update on key activities + publications related to water quality management and seek input on regulatory requirements for low-cost water quality test kits. Chair: Pranav Joshi ¦ Singapore Food Agency

13:30 – 14:15 Brief updates from WHO staff + discussion: ̶ Microplastics ̶ SDG monitoring and country estimates for safely

managed services ̶ Evaluation of point-of-use treatment products

14:15 – 15:00 ̶ Emerging, low-cost assays for fecal contamination: regulatory needs & requirements

Esther Shaylor ¦ UNICEF

15:00 – 15:15 Coffee / tea break 15:15 – 17:00 Session 6a. Managing chemical contaminants in drinking-water

Objectives: (i) present overview of WHO guidance on chemical contaminants; (ii) seek feedback practicability of guidance on selected parameters; and (iii) discuss questions from RegNet members related to chemical contaminants in drinking-water Chair: Rick Johnston ¦ WHO

15:15 – 15:45 Information sharing, risk assessment and communication on chemical contaminants

Jennifer De France ¦ WHO

15:45 – 16:55 Related member questions Roundtable 16:55 – 17:00 Wrap up Batsi Majuru ¦ WHO

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Friday 29 November 09:00 – 09:10 Reflections from Day 2 Joselito Riego De Dios ¦

Department of Health, Philippines

09:10 – 10:30 Session 6b: Case study: Managing chemical contaminants in drinking-water Objective(s): to consider a real-life case study of high-profile water quality and health issue, and exchange views on how to best respond in terms of overall appraisal of the situation, improvement plans and communication strategies Expected outputs / outcomes: (i) list of generic response actions that regulators should consider when faced with such situations; (ii) specific elements of monitoring and improvement plan for lead exceedances (iii) implications for regulation (e.g. interim limits, derogations); and (iv) communications strategy Chair: Rick Johnston ¦ WHO

09:10 – 09:20 Scene setting + objectives of case study + introduction of invited participants

Bruce Gordon ¦ WHO

09:20 – 09:50 - Context: countries & institutions involved in the water quality survey + roles

Samuel Diarri ¦ World Vision International Mike Fisher (tbc) ¦ Water Institute at University of North Carolina

09:50 – 10:10 What have been the responses to the findings? Interventions from national officials from study countries

10:10 – 10:30 Question 1: Is the current dataset adequate to inform a response? Question 2: If further actions are required to characterize the situation what are they?

David Cunliffe ¦ South Australia Department of Health, and John Fawell ¦ Independent Consultant

10:30 – 10:45 Coffee / tea break 10:45 – 12:30 Session 6b continued: Case study: Managing chemical contaminants in drinking-water

Chair: Bruce Gordon ¦ WHO 10:45 – 11:20 Question 3: Is there information on regulation of lead (past

and present) or other country experiences that could provide useful context?

11:20 – 12:00 Question 4: Is there sufficient data to suggest that action to begin drafting an improvement plan? Materials in contact with water: standards and compliance practices

Paul Bonsak ¦ World Plumbing Council

12:00 – 12:30 Roundtable discussion on proposed response and management strategy

12:30 – 13:30 Lunch 13:30 – 15:00 Session 7: Operation and functioning of RegNet

Objectives: seek input and consensus on priority directions and mechanisms for improving functioning of the network Bruce Gordon ¦ WHO

13:30 –14:00 14:00 – 15:00

Optimizing network functioning: Lessons from the International Food Safety Authorities Network (INFOSAN) Roundtable discussion Optimizing functioning of RegNet, priority focus areas and developing an investment case for the Network

Peter Ben-Embarek ¦ WHO

15:00 – 15:15 Coffee / tea break 15:15 – 16:00 Closing session

Bruce Gordon ¦ WHO Meeting summary and next steps Bruce Gordon ¦ WHO

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Closing remarks Maria Neira ¦ WHO End of meeting

Group photo in main foyer / Executive Board Room

22

Appendix 2: List of participants

Institution ¦ Country Participant

RegNet members

Ente Regulador de Agua y Saneamiento (ERAS) ¦ Argentina

Mr Alejo Molinari

Ente Regulador de Servicios Sanitarios de Santa Fe (ENRESS) ¦ Argentina

Mr Oscar Pintos

Health Canada Mr Yasir Sultan

Public Utilities Regulatory Commission (PURC) ¦ Ghana Ms Millicent Mensah

Water Services Regulatory Board (WASREB) ¦ Kenya Mr Richard Cheruiyot

Ministry of Health ¦ Italy Dr Lucia Bonnadonna

Ministry of Health ¦ Malaysia Mr Dzulkifli bin Mohamad

Mr Yahaya Bin Saad

Ministry of Health ¦ Morocco Mr Rachid Wahabi

Water Sector Regulatory Council (WSRC) ¦ occupied Palestinian Territories

Mr Mohammad Said Al Hmaidi

Department of Health ¦ Philippines Mr Joselito Riego de Dios

Entidade Reguladora dos Serviços de Águas e Resíduos (ERSAR) ¦ Portugal

Dr Susana Rodrigues

Singapore Food Agency Dr Pranav Joshi

Federal Food Safety and Veterinary Office (FSVO) ¦ Switzerland

Mr Pierre Studer

Department of Energy ¦ Abu Dhabi, United Arab Emirates Mr Abdulrahman Alalawi

Ms Khadija Hasan Bin Braik

Drinking Water Inspectorate (DWI) ¦ United Kingdom Ms Laura Moss

National Water Supply and Sanitation Council (NWASCO) ¦ Zambia

Mr Peter Mutale

Partners / invited participants

Ministry of Sanitation & Water Resources ¦ Ghana Ms Suzzy Abaidoo

Community Water Supply Agency (CWSA) ¦ Ghana Dr Worlanyo Kojo Siabi

Ministère de l’Hydraulique et de l’Assainissement ¦ Niger Mr Moussa Maman

International Association of Plumbing and Mechanical Officials (IAPMO)

Mr Seán Kearney

South Australia Department of Health Dr David Cunliffe (connecting remotely)

United Nations Children’s Fund (UNICEF) Ms Esther Shaylor (connecting remotely)

Water Institute at University of North Carolina Dr Mike Fisher (connecting remotely)

World Plumbing Council (WPC) Mr Paul Bonsak

World Vision International Mr Samuel Diarra (connecting remotely)

23

Dr Ray Norman

Independent Consultant Dr John Fawell (connecting remotely)

WHO

Coordinator, Water, Sanitation, Hygiene & Health Mr Bruce Gordon

Coordinator ai, International Food Safety Authorities Network (INFOSAN)

Dr Peter Ben-Embarek

Technical Officer, Water, Sanitation, Hygiene & Health Ms Jennifer De France

Technical Officer, Water, Sanitation, Hygiene & Health Dr Fiona Gore

Technical Officer, Water, Sanitation, Hygiene & Health Dr Rick Johnston

Technical Officer, Water, Sanitation, Hygiene & Health Dr Batsirai Majuru

Technical Officer, Water, Sanitation, Hygiene & Health Ms Kate Medlicott

Intern, Water, Sanitation, Hygiene & Health unit Ms Botho Motlhanka