Safe water access is recognized as a basic human right important for human health and dignity, as well as essential to the social and economic development of any community. In 2010, the United Nations adopted resolution 64/292, recognizing the right to safe and clean drinking water as a human right. Yet nearly 750 million people still depend on unimproved sources of drinking water with increased risk to diarrheal diseases; half of these are in sub-Saharan Africa.1 The East African countries of Kenya, Uganda, and Tanzania all border Lake Victoria, the second largest freshwater lake in the world. However, the close proximity to a large body of freshwater and major cities has little bearing on access to safe water for many of the rural communities. In 2006, only 57 percent of Kenya’s 36.6 million people had access to improved drinking water. Updated coverage of water access for Kenya according to the WHO/UNICEF Joint Monitoring Program’s report in 2015 is shown in Table 1.2
Diarrheal disease is reported to be the second leading cause of death in children under five years old, and is responsible for killing around 760,000 children every year.3 In an effort to reverse this situation, the global community resolved to halve the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015 through Goal 7 of the UN Millennium Development Goals (MDGs). Although the MDG target for drinking water was met five years ahead of schedule, a significant proportion of the population in sub-Saharan Africa still contends with consumption of untreated water from rivers, lakes, ponds, and irrigation canals as their main sources of drinking water, particularly in the rural areas, where more than 80 percent of the approximately 768 million people who have no access to an improved water source globally live.4 The World Health Organization and UNICEF estimate that 84 percent of rural communities have access to improved drinking water sources, as opposed to 94 percent of urban populations.2 At the conclusion of the MDG period, a new universal agenda was formulated in the form of a set of integrated Sustainable Development Goals (SDGs). Reduction of water-related diseases is part of Goals 3 and 6 of this new agenda, which aim to ensure a substantial reduction in the number of deaths and illnesses caused by water contamination and the availability and sustainable management of safe water and sanitation for all ages by 2030.5 Achieving these goals will require intense scaling up of water development infrastructure in areas that performed below target for the MDGs.
Women and Water
As the managers of households, women bear the primary responsibility for providing water and ensuring its quality in much of the world today. It is reported that their involvement can make water projects six to seven times more effective.6 Whereas women’s participation in water provisioning requires upfront capital, many financial institutions generally do not have confidence in rural women’s capacity to repay loans, and thus their access to financial resources is limited. Fortunately, women in many parts of the developing world are finding strength in numbers by working in groups to achieve goals that would otherwise be impossible individually. In Kenya, this takes on the form of “Chama,” which is Swahili for a group of people with a common goal. Several “Chama” categories are recognized, such as self-help groups, merry-go-rounds, or investment groups in which members pay an amount of money every week or month to be used by the group for investment, loans, or dividends from their microsavings.7 “Chamas” were originally popularized by women and were almost exclusively made up of women coming together for the purpose of improving the well-being of their families, usually transacting small sums of money. This is no longer the case. These groups can be women, men, or mixed gender and can involve transactions of millions of shillings. This platform is popular with women’s groups in the Lake Victoria region of Kenya, and is now being used by Kisian women to access safe water.
Kisian Women’s Group
Kisian Community is located approximately 12 kilometers from the city of Kisumu on the shores of Lake Victoria in western Kenya. The city has made great strides in developing the water sector but has yet to lay the infrastructure that is required to bring the peri-urban and rural areas safe water commodities and services. Community members therefore depend on unimproved water options such wells or lake, river, or pond surface water for their households (Table 2). Kisian women play a major role in maintaining the well-being of their households, a role that has over time expanded to include income generation to supplement that of their husbands. Forming groups for income generation is thus popular in the community. The Kisian Women’s Group, consisting of 25 women, was initially formed as a “Merry-Go-Round,” contributing very small amounts of money every week to give one member on a rotational basis. These contributions have grown into amounts that have enabled them to open a savings account, with plans in the near future to start a group project and provide loans from their own savings. Through their collaborative activities with the non-governmental organization Community Health Support program (COHESU),8 Kisian women initiated a program of purchasing biosand filters for safe water. They chose to do this through external microfinancing, with COHESU facilitating access to microfinance and training in water and health. The women act as each other’s guarantors, thus ensuring that each member repays her loan installment at each meeting.
Biosand filters were chosen after consideration of the socio-economic status of community members and the difficulty of accessing piped water due to cost and distance from the nearest piped water source.9 The filters are sourced from Aqua Clara International,10 and COHESU organizes for the delivery of the sand filters to the community. COHESU also provides training to the women on the linkages between unsafe water and health, while Aqua Clara International offers trainings on the usage and maintenance of the biosand filters.
In preparation for the installation of sand filters, dialogues were held with the group on the topics of water filtration and water treatment methods, as well as options for financing the filters, either internally within the group or by external microfinance. The women were also given time to discuss the filters with their families. The women chose external microfinancing since their savings were not yet at a level that could finance the filters for all group members. After installation, the filters were monitored on a weekly basis by COHESU personnel for breakdowns, maintenance, and efficiency of filtration, while cultures of the water were taken every three months by Aqua Clara to determine the quality of the filtered water.
Twelve members of the group have had the filters installed so far. COHESU provides continuous education to create awareness of the importance of water quality and its relation to reduction in disease burden.
Progress for Kisian Women
Apart from the weekly inspection of the filters, monitoring is also conducted through updates by the women during their weekly meetings, whereby the women provide feedback on acceptance and performance of the filters. So far, no woman has neglected or stopped using the filters. Initially, filter maintenance varied from house to house, but with more training, the women were more consistent in the proper maintenance of the filters. None of the households of those with filters has reported any diarrhea cases in the six months post-installation. The primary source of water for the different households varied significantly and created differences in how fast the water from the filters improved. For most of the women, the primary source was river water. One woman was using unprotected well water, and rain water was also used by all during the wet season. These differences in water sources led to variability in the rate at which water from different households cleared. Less turbid water cleared fast after installation, while it took much longer for the water from more polluted sites to clear. To overcome this issue, the group was advised to allow the highly polluted water to sediment in a different container before pouring it into the biosand filters, which greatly improved the water.
During the weekly discussions, it appears that the introduction of the filters has boosted the knowledge for safe water and its impacts on health. Some households share the filters in a number of compounds, and an interest in industrial sand filters has been expressed. Management of the filters and the quality of water is continuously improving.
One of the most profound statements that we heard from one of the Kisian women was that, “I can now carry my own bottled water when I go to public places and travel.” This particular statement was related not only to the quality of the water but also to the perceived dignity associated with carrying clean bottled water for drinking in public.
The WHO has guidance for monitoring and evaluating household water treatment and safe storage, which sets out performance criteria based on either the reduction of different types of pathogens or a proven health impact.11 Various studies have shown the impacts of the biosand filter on health (see below), largely demonstrating that the filters meet the WHO requirements for impacts on health, particularly in peri-urban and rural settings such as Kisian, where resources are limited and surface water is being used.
The focus for the Kisian women now is to get the filters to work at optimum performance. A number of challenges have been encountered and tackled in this pursuit. Experience has shown the need for continuous training and monitoring. It is important to note that no free filter was given out, and all the loans were repaid, indicating that improved knowledge for safe water must go hand in hand with economic empowerment of the women in the community. It will be interesting to see the long-term uptake of the filters through the “Chama” platform for the rest of the group members, and other groups in the community, and how long and well the filters are maintained. It will also be interesting to systematically monitor the impacts of this intervention on health.
Sand Filters: Three Selected Studies
- Duration of filter use ranged from <1 to 12 years. Kaplan-Meier analysis of filter lifespans showed that filter use remained high (>85 percent) up to seven years after installation. Several filters were still in use after 12 years, which is longer than documented in any previous study. Filtered water from 25 filters (86 percent) contained Escherichia coli concentrations of <20 most probable number of coliforms/100mL. Recontamination of stored filter water was negligible. Comparable results from previous studies in the same region and elsewhere show that biosand filter technology continues to be an effective and sustainable water treatment method in developing countries worldwide.12
- This study identified that ceramic and biosand household water filters are the most effective and have the greatest potential to become widely used and sustainable for improving household water quality to reduce water-borne disease and death.13
- Biosand filtration reduced diarrhea by approximately 50 percent consistently across five trials from low- to middle-income settings, again regardless of whether the water source or sanitation was improved or unimproved.14
This project continues to receive support in the form of great encouragement and financial donations of Friends of COHESU to whom we extend our sincere gratitude. We are thankful to TOMS Shoes for their donation of shoes to the children of participating communities, and to the staff of Aqua Clara International-Kenya for their expertise and technical support in the implementation of the project.
We express our sincere thanks to COHESU volunteers who devote their time and knowledge in the implementation of this project, and to all the women of Kisian and their families for their enthusiasm and quest for knowledge, without which the project would not have achieved the current level of success. We are grateful to the management and staff of COHESU for their constant support.
- WHO & UNICEF. Progress on drinking water and sanitation: 2014 Update. (WHO Press, Geneva, 2014).
- WHO and UNICEF Joint Monitoring Programme. Progress on Drinking Water and Sanitation, 2015 Update and MDG Assessment [online] (2015). http://www.wssinfo.org/documents/?tx_displaycontroller[type]=country_files.
- WHO. Diarrheal disease. Fact sheet N°330 [online] (2013). http://www.who.int/mediacentre/factsheets/fs330/en/.
- WHO & UNICEF. Progress on sanitation and drinking-water. 2013 update (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, New York, 2013).
- A new sustainable development agenda. UNDP [online] (2016). http://www.undp.org/content/undp/en/home/sdgoverview.html.
- Women at the centre of water, sanitation and hygiene programmes. Water Supply and Sanitation Collaborative Council [online] (2006). http://www.eldis.org/go/home&id=19726&type=Document#.V8IESlt97IX.
- Chama: The economic model that’s all the rage in Kenya. Voices of Africa [online] (2013). http://voicesofafrica.co.za/chama-the-economic-model-thats-all-the-rage-in-kenya/.
- COHESU [online] (2001). www.cohesu.com.
- Bisung, E et al. One community’s journey to lobby for water in an environment of privatized water: is Usoma too poor for the pro-poor program? African Geographical Review 35(1): 70–82 (2016).
- Where We Work: Kenya. Aqua Clara International [online] (2016). http://aquaclara.org/where-we-work/kenya/.
- WHO & UNICEF. Household water treatment and safe storage. Toolkit for monitoring and evaluating household water [online] (2012). http://www.who.int/household_water/resources/toolkit_monitoring_evaluating/en/.
- Sisson, AJ, Wampler, PJ, Rediske, RR, McNair, JN & Frobish, DJ. Long-term field performance of biosand filters in the Artibonite Valley, Haiti. American Journal of Tropical Medicine and Hygiene 88(5): 862–867 (2013).
- Sobsey, MD, Stauber, E, Casanova, LM, Brown, JM & Elliott, MA. Point of use household drinking water filtration: a practical, effective solution for providing sustained access to safe drinking water in the developing world department of environmental sciences and engineering. Environmental Science and Technology 42(12): 4261–4267 (2008).
- Clasen, TF et al. Interventions to improve water quality for preventing diarrhea. Cochrane Database of Systematic Reviews 10: CD004794 (2015).