wef09 talk -desmyster at al, monitoring and evaluation of 1,000 households receiving ceramic pot...

8/14/2019 WEF09 Talk -Desmyster at Al, Monitoring and Evaluation of 1,000 Households Receiving Ceramic Pot (Kosim) Filters

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Monitoring and Evaluation of 1,000 Households receiving

Ceramic Pot (Kosim) Filters after an Emergency Flood Mass

Distribution in Northern Ghana

Davy Desmyter (Pure Home Water), Abaazan P. Adagwine(Pure Home Water),

Shakool Ibrahim(Pure Home Water), Mary Kay Jackson, P.E.

(Pure Home Water),

Susan E. Murcott(Massachusetts Institute of Technology)

Civil and Environmental Engineering Department

Massachusetts Institute of Technology

77 Massachusetts Avenue, 1-138, Cambridge, MA 02139

ABSTRACT

Background: In September 2007, Northern Ghana experienced severe flooding. An

estimated 200,000 people were displaced; both groundwater and surface water

supplies were contaminated. UNICEF-Ghana, sponsored by the European Commission

and with the District Governments, contracted Pure Home Water (PHW) to distribute

5,000 Ceramic Pot (Kosim) Water Filters to affected remote rural communities in the

Northern and Upper East Regions. PHW and the local Environmental Health staff

performed the distribution, an education & training program, and follow-up

monitoring and evaluation of 1,000 households in 23 rural communities 3 to 6 monthslater.

Objective: Given that ceramic pot filters were a new type of emergency intervention

for UNICEF, the goal of the monitoring and evaluation study was to learn how the filter

is used and maintained, to determine the community acceptance of the filter and to

ascertain rates of sustained use.

Results: All households were identified by GPS coordinates and all villages receiving

filters were mapped. PHW found that 64% of filters were still in use after 3 to 6

months: 12% of ceramic filters were no longer in use because of a malfunctioning filterand 24% because of resumed access to improved water sources. Whereas breakage

had formerly been a problem for PHW in long-distance transport, this issue was

resolved when PHW assumed responsibility for transport directly to communities. 95%

of all breakage occurred in the household, with the ceramic pot being the most fragile

element of the ceramic filter unit. 5 % of breakage was of the safe storage container.

To allow the tap to fit in, the plastic container is perforated and is the weakest spot.

Leakage occurred when the tap was incorrectly inserted, typically due to heavy-

handed tap installation. The main reason why households stopped using the filters

(24%) was that their access to an improved water source, such as a borehole or


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protected dug-well, resumed post emergency and/or the availability of rain water

during the wet season. A scoring system rated the success of both the District

Government and the community roles, including also each project phase: distribution,

training and education, treatment and maintenance, monitoring and re-education,

appreciation. Each theme was scored in each community and recommendations for

improvement in future distributions were communicated to UNICEF and have been

posted on-line at: http://web.mit.edu/watsan/meng_ghana/html

KEY WORDS: ceramic pot filters, household drinking water treatment and safe

storage, monitoring and evaluation, emergency, water quality, water supply, Ghana

INTRODUCTION

The Flood: In September 2007, Northern Ghana experienced severe weather

conditions, resulting in massive flooding in the Northern and Upper-East Regions of

the country (Figure 1). An estimated 200,000 people were displaced from their homes

and at least 30 people lost their lives due to this natural disaster. Both improved1

and

unimproved2

water supplies were contaminated by flood waters, creating concerns

about the risk for a widespread outbreak of waterborne disease such as cholera and

diarrhoea, as well as potential for increased cases of Guinea worm in Ghana, which

already has the stigma of being one of the countries with the most cases of Guinea

worm in the world, second only to Sudan.

1An improved water supply is: household connection, public standpipe, borehole, protected dug well,protected spring, rainwater collection.

2An unimproved water supply is: unprotected well, unprotected spring, rivers/streams/irrigation channels,lakes/ponds, vendor-provided water, tanker truck water, bottled water.

Figure 1: Northern Ghana Districts affected by the September 2007 floods


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In a well-coordinated emergency response effort, UNICEF, sponsored by the European

Commission and in concert with the Regional Governments, contracted Pure Home

Water (PHW) for the distribution ofKosim Ceramic Pot Filters to the households that

were most affected by contamination of their drinking water supplies due to the

flooding.

Pure Home Water: PHW is a legally registered Ghanaian non-profit social enterprise,

founded in 2005 and located in Tamale, Northern Region, Ghana. The organizations

aim is to disseminate small-scale, proven technologies for the treatment and safe

storage of water as a complement to other efforts on the part of the government, the

non-profit and private sectors to address water/sanitation/hygiene issues. PHW has

trained field personnel who know how to successfully integrate the Kosim filter and

other household drinking water treatment and safe storage (HWTS) technologies into

homes.

Five thousand Kosim filters were distributed to provide safe drinking water to

households in the flood-stricken rural communities of the East Mamprusi, Zabzugu-

Tatali and East-Gonja Districts of the Northern Region and throughout the flooded

areas in the Bongo, Talensi-Nabdam, Garu-Tempane, Builsa, Kassena Nankana (KNDA)

and Bolgatanga Municipal Districts of the Upper East Region. This paper documents

the results from monitoring the subsequent use of filters in these six Upper East

districts.

Kosim Ceramic Pot Filter: The Kosim3filter is the Ghanaian version of the Potters for

Peace ceramic pot filter, developed by Fernando Mazariegos in Guatemala in 1981.

PHW has directly sold or distributed this filter to over 11,000 households in Ghana

between 2005-2008. The Kosim filter consists of a ceramic pot, plastic safe-storage

container, top ring, lid, tap, brush, instruction sheet and one Aquatab. If correctly

operated and maintained, the Kosim filter has a proven life span of 3+ years. These

filters are manufactured in Accra, Ghana, about 450 miles south of the flood-affected

areas.

3Kosim is the word for pure water in the Dagbani language, a major local language of Northern Ghana.

Figure 2: The Kosim Ceramic Filter


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In terms of this filters impact, water quality tests performed by Massachusetts

Institute of Technology researchers in Ghana showed an average 99.7% reduction ofE.

coli, 99.4% reduction in total coliforms and a 92% reduction in turbidity from the

source water to the filtered water in a one-year follow-up in 41 households. (Johnson

at al, 2007). Health impact studies showed that traditional rural households relying on

unimproved water supplies using the ceramic pot filter were 69% less likely to have

diarrhoea than people without the filter (RR. 0.31, 95% CI, p-value 0.035) (Johnson et

al, 2007). The ceramic filter is also known to remove the cyclops water flea that carries

the Guinea worm larva.

METHODOLOGY

From November 2007 to April 2008, PHW provided 5,000 Kosim ceramic pot filters

together with taps, brushes and PHW/UNICEF informational stickers to UNICEF for

distribution in designated districts in the Northern and Upper East Regions.

PHW procured 5,000 Kosim filters and transported them to Tamale for collection and

distribution by UNICEF from November 2007 until January 2008. The district

government and UNICEF determined which rural communities had been most affected

by the flooding and how many filter units would be reserved for each of these

communities. UNICEF targeted 4 villages in all the districts except KNDA, where five

villages were targeted. The targets were based on a rapid emergency response to

human suffering and the potential for widespread waterborne disease in the area due

to severe flooding.

Then the EHSU staff of the respective districts governments distributed 3,000 Kosim

filters from temporary depots to selected communities during November and

December 2007. Beginning in January 2008, UNICEF contracted PHW to distribute the

remaining 2,000 filters directly to other selected beneficiary communities. This

distribution was completed by April 2008. PHW distributed filter units to 23

communities in 6 designated districts in the Upper East Region: Bolga, Garu/Tempane,

Talensi/Nabadem, Bonga, Kassena Nankana (KNDA), and Builsa (Figure 3).


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Figure 3: Upper East Districts and Communities Monitored by Pure Home Water

A seventh district, Bawku, was intended, but distribution did not go forward there

because of local civil unrest. Prior to distribution, PHW management and staff

conducted a one-day training of field personnel from Ghanaian Regional

Environmental Health and Sanitation Units (EHSU) on the proper use and maintenance

of the filter. The purpose of the training program was to familiarize the beneficiaries

and the local Environmental Health staff with the basic concepts of proper household

water treatment and safe storage (HWTS). Participants learned about the hazards of

contaminated drinking water and how to properly assemble, operate and maintain the

Kosim ceramic filter unit for maximum effectiveness and longevity. The Environmental

Health staff was also taught how to effectively monitor and, if necessary, re-educate

the beneficiary households.

The EHSU had trained field personnel, familiar with and trusted by the communities to

be reached, who assisted PHW in the process of delivery, acceptance and monitoring

follow-up of the water filters. In addition to the EHSU, PHW liaised with the

Community Water and Sanitation Agency (CWSA), which is the entity responsible for

rural water and sanitation in Ghana and with the Ghanaian Regional Environmental

Health Officer. The responsibility for the filter delivery belonged to PHW, but

assistance from the EHSU Officer and EHSU teams was imperative in order to meet

this obligation. Regular follow-up was the responsibility of these government

organizations, not PHW, as they were based locally and had roots in the communities.

In addition to the governments ongoing follow-up responsibilities, PHW undertook a

short-term monitoring and evaluation program, spanning the 3-month period from

June through August 2008, and involving the full-time work of 4 PHW staff.


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Three to six months after distribution and accompanied by a local CWSA or EHSU

representative, PHW performed follow-up monitoring at the community and the

individual household level in 23 communities and 1,001 households. The purpose of

the follow-up was to ensure that every individual household had received and was

properly using each individual filter and to reinforce the importance of proper

handling of the filter in order to prevent breakage.

PHWs overall purpose in carrying out the monitoring and evaluation program was

two-fold: to determine the district governments role in the ceramic filter distribution,

and to follow-up at the household level to determine the communitys and users role

in effective use of their ceramic filters. The overall assessment resulted in one page

assessment sheets. Each cover sheet was the District Assessment. Subsequent one

page sheets covered the individual Community Assessments within that district. The

District Assessment was qualitative, based on expert judgment. The Community/userAssessment was semi-quantitative, following a monitoring checklist of 32 questions.

To assess the district governments role in each of the districts, PHW interviewed the

government EHSU staff who were responsible for the follow-up and monitoring of the

beneficiaries. Topics discussed during these unscripted interviews were typically:

government staff appreciation for the ceramic filter;

monitoring issues encountered by the government;

availability of resources to perform their monitoring in the field;

breakage, leakage and product quality issues;

availability of replacement parts and services;

requests for distribution in other areas or communities;

other suggestions and recommendations.

The major insights derived from these District Government and EHSU meetings were

sorted into two themes, compliments and concerns, and a set of recommendations

was developed for each district.

In the beneficiary communities, PHW monitoring visits took place in the compound

where the filter was set up, enabling the PHW monitor to:

conduct the interview in the environment where the filter is usually operated;

inspect the filter within its direct surroundings and observe how the

beneficiary operates and maintains the filter;

re-educate the beneficiary by demonstrating with his/her own filter.

Each script-based interview was a focused session structured around a 32 question

Ceramic Filter and User Monitoring Checklist developed by UNICEF-Ghana. The

interview was between the person who usually controls the use and maintenance of

the filter and the PHW monitor and was focused on:


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situational assessment;

treatment or use of the filter unit;

maintenance of the filter unit;

storage of the filtered water;

appreciation for the filter unit;

physical inspection or observation of the filter unit;

re-education of the beneficiary, if needed.

A baseline was not established prior to the filter distribution. Water quality tests of

source water and filter treated water were not conducted. Survey questions related to

health, water-borne illness were not part of the Monitoring Checklist. Because of the

emergency nature of this distribution, neither pairing of users with non-users was

performed, nor were flood victims randomized during distribution or assessment.

PHW monitors were trained to conduct interviews in such a way that:4

he/she understood the objectives, subject matter and vocabulary of the

survey;

the beneficiary could comfortably talk with a friendly local, at the same level

and, if possible, in their own local language (there are over 70 local languages

in Ghana, including several distinctly different languages in the Upper East);

the beneficiary was never interrupted, manipulated or prompted for a certain

answer;

the beneficiary felt respected and never judged, embarrassed or forced.

At the end of each interview, the monitored filter unit was marked with an original

identification number and mapped using GPS coordinates.

All community data was sorted and assessed according to five main appraisal themes:

Distribution

Did the project reach the targeted beneficiaries?

Were filters effectively dispersed over the community?

Training & Health Education

Did the health education create sufficient awareness about proper household

water treatment and safe water storage (HWTS)?

4Adapted from: Whittington, Dale. 2002. Improving the Performance of Contingent Valuation Studies in

Developing Countries Environmental and Resource Economics 22:323-367, 2002. Kluwer Academic

Publishers, Netherlands


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Were the ceramic filter operational & maintenance training concepts

successfully adopted?

Treatment & Maintenance

Is the ceramic filter effectively operated and properly maintained?

Is the trained beneficiary the dedicated person to control the filter in the

household?

What is filtered water used for?

Does the household apply other water treatment methods?

Is filtered water stored anywhere else in the household?

If a given household was not using its filter, what are the main reasons why

that household decided to stop using it?

Monitoring & Re-education

Is the Government Field staff effectively and regularly performing the

monitoring rounds?

What are the typical re-education topics?

What are the most frequently asked questions by beneficiaries?

Appreciation

Does the community appreciate the ceramic filter?

According to beneficiaries, what are the benefits of using the ceramic filter?

Each theme was evaluated and graded, using following scoring system:

Figure 4: Scoring System for Community Assessment

: EXCELLENT activity successful

: GOOD regular follow-up advisable

: PASSABLE improvement and follow-up advisable

: PROBLEMATIC reappraisal for alternative solution

: UNSATISFACTORY suspension of services

The data resulting from these interviews and the observations in the field forms the

basis for the results described below. For each score below EXCELLENT (5/5), general

recommendations as to how short-comings could be overcome, processes improved

or issues resolved were suggested.


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RESULTS

Monitoring results take three forms: macro results are from an analysis of the 1001

users database, District Government Assessments from the qualitative evaluation of

the local governments role, and Community/user Assessments. The macro results aredepicted graphically in Figures 5 - 9. Figure 5 shows that 56% of users obtain their

drinking water from unimproved water supplies as opposed to 44% who obtain it from

improved supplies. This high percentage of unimproved water supply users makes

sense, given that the UNICEF emergency filter distribution specifically intended to

provide filters to those with unimproved sources and to supply users of improved, but

potentially contaminated, sources with chlorine tablets. That there was still a high

percentage (44%) of users whose water came from improved sources suggests that

targeting to flood victims with unimproved water supplies was only partially

successful.

Figure 5: Percentage Water Source Types among Flood Victims, Upper East, Ghana

0

10

20

30

40

50

60Unimproved

Improved

(space)

Borehole

Protected Hand-dugWell

Unprotected Hand-dug Well

River, Stream

Dam, Dug-out

Pond

Other

56%

Unimproved

44%

Improved


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Figures 6 and 7 indicate respectively who fetches and who manages the filter within

the beneficiary household. The answer is overwhelmingly women: 87% of women

fetch water as opposed to only 11% of children and 2% of men. And a whopping 96%

of women manage the filter.

Figure 6: Who Fetches Water? Figure 7: Who Manages the Filter?

Figures 8 and 9 indicate that breakage in the home is the leading problem that

households face in using the filter. However, Figure 9 shows that the leading cause of

discontinued use is because of resumption of improved water supply, presumed by

users to be safe. Twenty-four percent stopped using the filter because of this

presumed safe supply, in contrast to 12% who discontinued using the filter over a 3 to

6 month period because of breakage. This rate of discontinued use compares closelyto the high end of rates found in Cambodia by Brown et al. of about 2% discontinued

use per month (WSP/UNICEF, 2007).

Figure 8: % Users with Filter Problems Figure 9: Filters in Use 6-9 Months Later?

The District Assessment results are presented on the following data sheets by giving

one example each of a favorable result and an unfavorable District result. The results

in the Builsa District Assessment are resoundingly positive, while the Bolgatanga

District Assessment is highly negative. These two examples bracket the range of


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the highest field activity levels that PHW has witnessed in the Upper-East region, they

confidently master the operational and maintenance instructions of the ceramic filter

and they fully understand the benefits of the system.

Concerns

Nevertheless the Builsa district suffers from similar deficiencies as its neighbouring

districts in the Upper-East. Next to a lack of human resources, there is a serious need

for financial resources to support the mobility of the local staff. All the same it should

be inspiring for colleagues in other districts to witness the creativity that the Builsa

government staff apply to enable themselves to actively continue their community

services in the field. Finally, during monitoring rounds they found a need for

replacement parts and they advise that filters should be distributed to each household

in every community, not only those that were directly affected by the floods.

Recommendations

A PHW team should revisit the Builsa communities to offer replacement services to

the households that have malfunctioning filter units and to distribute Kosim ceramic

filter units to each household that has not yet received one.

The local government health staff should continue regular surveillance and health

education to support the beneficiaries towards effective use of the system.

Bolgatanga Municipal District Assessment

In the Bolgatanga Municipal District, PHW interviewed a total of 158 beneficiaries in

four monitored communities: Soe Yipala, Dachio, Kumbosco and Kumbangli.

Monitored Communities in Bolgatanga Municipal District Ceramic Filter Use in Bolgatanga Municipal District

In Use

68%

Not In

Use32%

Ceramic Filter Use


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Environmental Health Field Staff Interview Summary

Compliments

The government field staff of the Bolgatanga Municipal district appears ratherindifferent towards the use of ceramic filters. Most probably that is due to the fact

that this district did not specifically dedicate field staff to the follow-up of the

communities where ceramic filters have been distributed.

Concerns

Likewise to its counterparts, the Bolgatanga district endures a serious lack of material

resources and motivated human resources, resulting in disrupted and ineffective field

activities. Based on the information acquired during PHW household interviews, we

can conclude that virtually no monitoring visits have been performed in this district;the local staff even turns out to be unfamiliar with the geographical location of the

communities where filters have been distributed. Therefore no reports, suggestions or

concerns were recorded from district staff. Households do report replacement needs

and put forward mixed feelings amongst community members because some did and

others did not receive a ceramic filter.

Recommendations

A PHW team should revisit the Bolgatanga Municipal communities to offer

replacement services to the households that have malfunctioning filter units and to

distribute ceramic filter units to each household that has not yet receive one.

Furthermore a number of dedicated local government field staff who are familiar with

the communities that received ceramic filters, should be selected and trained to

perform monitoring visits and health education and to convince the beneficiaries to

continue to use the filter effectively.

Balungu Community Assessment, Bongo District

PopulationNo:

544 Distribution Date: 8 February 2008

HouseholdNo:

102 Distribution No: 32

CompoundNo:

65 Monitoring Date: 18 June 2008

Watersource(s):

stream, borehole MonitoredHousehold No:

24


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Monitored Households in Balungu Ceramic Filter Use in Balungu

Distribution score:

Observation: The distribution was successful, although more filters should have been dispersed

to cover every flood-affected household in this community. Certain households received more

than one filter to serve the numerous family members, while other households could only

observe in disappointment.

Training & Health Education score:

Observation: The health education and operational & maintenance training turned out highly

successful.

Treatment & Maintenance score:

Observation: Filters are excellently handled and properly maintained on a regular basis. The

trained beneficiary is usually the person who is dedicated to controlling the filter unit. Due to

scarcity, filtered water only serves for drinking purposes. The households in this community do

not apply methods other then the ceramic filter to treat their drinking water. The storage

container of the ceramic filter is the only safe water storage vessel in these households.

Malfunctioning filters are the single reason for discontinued use in this community.

Monitoring & Re-education score:

Observation: The government field staff is doing an outstanding job. Monitoring rounds are

performed on a regular basis and the little re-education that is necessary in this community is

focused on the location and hygienic use of the drinking vessel, the position of the ceramic

filter unit in the compound, the cleaning and frequency of cleaning of the ceramic pot and the

overfilling of the safe storage container. Frequently asked question: Where can I find

replacement parts?

Appreciation score:

In Use

96%

Not In

Use

4%

Ceramic Filter Use


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Observation: The households in this community are very grateful for receiving the filters and

cheerful because of our monitoring visit. Beneficiaries say they have now become inseparable

from their filters because they are no longer troubled by abdominal pains and diarrhoea;

furthermore the quality and taste of their drinking water has significantly improved. Those

with malfunctioning filters are eagerly asking how they can repair their filter. Households thatdid not receive a filter are trying to convince PHW to bring more filters soon.

Buarboka Community Assessment, Garu Tempane District

Population

No:

2138 Distribution Date: 3 March 2008

Household No: 304 Distribution No: 64

Compound No: 256 Monitoring Date: 19 June 2008

Water

source(s):

hand dug well, borehole, pipe Monitored Household

No:

6

Monitored households in Buarboka Ceramic Filter Use in Buarboka

Distribution score:

Observation: The distribution in this community turned out to be disastrous as most ofthe filters missed their target beneficiaries because they were distributed on a market

day and so ended up in the homes of visitors from nearby communities that were

unaffected by the floods. Out of sixty-four filters distributed, only a fraction were found

here; it is not clear where the other filters are.

Training & Health Education score:

Observation: Similar to the distribution, both the training and health education are

deemed highly unsuccessful.

In Use50%

Not In

Use

50%

Ceramic Filter Use


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Treatment & Maintenance score:

Observation: The few filters found in this community were poorly handled and maintained.

Due to scarcity, filtered water is only used for drinking purposes. Households in this

community generally do not treat drinking water; furthermore they see no reason whythey should use the ceramic filter. For those that do use the filter, the storage container of

the ceramic filter is the only safe water storage vessel. Reasons for discontinued use are

breakage, leakage and a general disinterest for the system.

Monitoring & Re-education score:

Observation: The government field staff is not executing the monitoring rounds.

Unfortunately, the first monitoring visits were performed by the PHW team. Not

surprisingly the government field staff was unaware of the unfortunate situation in the

field. Re-education during the PHW monitoring round was focused on all training and

health education topics.

Appreciation score:

Observation: The households in this community have no interest nor display any curiosity for

the ceramic filters.

The last two data sheets are from the Community/User Assessments. Again both

favorable and unfavorable results have been presented: the Balungu Community

Assessment and the Buarboka Community Assessment, respectively. The favorable

result from Balungu, a community of 102 households, is one where only 4% of filtersare not in use. Assessments here are in glowing terms. Filters are excellently handled

and properly maintained on a regular basis. The government field staff is doing an

outstanding job. Monitoring rounds are performed on a regular basis and little re-

education is necessary. Compared to Balungu, the community of Buarboka is

seriously lacking. The distribution in this community turned out to be disastrous as

most of the filters missed their target beneficiaries. The government field staff is not

executing the monitoring rounds. Unfortunately, the first monitoring visits were

performed by the PHW team. Not surprisingly the government field staff was unaware

of the unfortunate situation in the field.

DISCUSSION/RECOMMENDATIONS

The widespread distribution of a large number of filters in a relatively short period of

time, followed by comprehensive monitoring and evaluation of sustained use provides

a wonderful opportunity to acknowledge program successes, strengthen program

short-comings and learn from program failures. All of the recommendations that

came out in the monitoring and evaluation are being seriously reviewed by both

UNICEF and PHW and implemented in a new filter distribution program in two new


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districts as of January 2009. Below we discuss key recommendations, solutions and

plans for new distributions.

Distribution

Issue: The local Government Environmental Health officers were responsible for the

selection of the target beneficiaries. They assessed the situation in the field and

investigated which communities and specifically which households in those

communities had been worst hit by the floods. Subsequently they advised UNICEF on

the number of filters needed and where exactly these should be delivered. UNICEF

then contracted PHW to join the government staff in the field for the health

education, training and finally the distribution. Unfortunately the government field

staff never prepared a list of beneficiaries before the actual distribution phase. In

many communities this resulted in a rather ad hoc selection of beneficiaries at the

moment of the distribution itself; those that were fast enough to register their name

as beneficiary received a filter. Additionally, in most communities the number of

flood-affected households greatly exceeded the number of available ceramic filters.

This limited number of filters often ended up poorly dispersed, sometimes clustered in

less flood-affected areas of the community, and often those families that were

impacted the most were left without this much-needed intervention.

Possible Solutions: During the assessment phase, before the filters actually arrive in

the community, the government field staff should carefully identify and map the most

affected community area(s) and list the households that live there as targeted

beneficiaries. The number of listed households then determines the exact number of

ceramic filters required for that community. Subsequently, in the distribution phase,

this list will guide the team to accurately disperse the filters to the right people.

Another approach would be to completely blanket target communities, insuring that

every household received one or more filters, depending on family size. Again, the

government field staff should map the area and count the households to make sure

that a sufficient number of filter units are delivered to the community.

Plan for Next Distribution: For the next UNICEF distribution, PHW has been asked to

provide filters for every household in the beneficiary community. PHW will work

closely with the government field staff to make sure that enough filters are delivered

to each community to meet this blanket demand. In addition, PHW will distribute the

filters by going from household to household, rather than handing out filters at a

centralized location. In this way, PHW hopes to keep distribution to the target

community and avoid unplanned distribution to households in neighboring

communities.


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Training & Health Education

Issue: In each community, beneficiaries were assembled in a large group to attend a

standard, one-way health education and filter training; standard because every

community received the same training and one-way because this training generallyinstructed the beneficiaries without allowing much space for interaction or exercise.

This method resulted in less-effective trainings.

Solution: Trainings should be conducted with small groups of beneficiaries, enabling

the trainees to interact during the training process and allowing them an opportunity

to perform easily understood and practical exercises that will familiarize them with the

basic concepts of proper household water treatment and safe storage, the hazards of

contaminated drinking water, and how to properly assemble, operate and maintain

the ceramic filter for maximum effectiveness. Training programs should vary based on

community specific situations, e.g. many beneficiaries that are fortunate enough to

have access to improved water sources in their community, will shortly after the flood-

affected water source has been decontaminated, stop using the ceramic filter because

drinking water taken from that source is then considered clean. For such communities,

the training should educate the beneficiaries on the benefits of filtering not only

unimproved water supplies, but also improved water supplies such as borehole and

rain water, also on how to use the Kosim filter safe storage container for safe drinking

water storage. Moreover, the concept and use of AquaTabs could be introduced and

distributed in the community.

Plan for Next Distribution: For the next UNICEF distribution, PHW will conduct training

sessions for small clusters of adjacent households, probably 5 to 8 households at a

time. Training has been updated to include a segment on the benefits of continuing to

use the filter even on perceived safe sources of water.

Discontinued Use

Issue: 6 to 12 months after the distribution, some ceramic filters are no longer in use.

12% because of a malfunctioning filter. While the breakage rate is 12% in aggregate, it

is as low as 5% and as high as 45% in specific communities.

24% because of access to improved water sources or other reasons

(i) Malfunctioning Filters

Breakage

95% of all breakage occurs with the ceramic pot (a fired clay pot), the most fragile

element of the Kosim ceramic filter unit. If not handled with care, one can easily break


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or crack the pot rendering it useless: a cracked or broken pot will no longer effectively

filter the water. Although the whole pot is fragile and will break if dropped to the

floor, the weakest spot is definitely the lip (the part that allows the pot to rest on top

of the ring lid). Lip breakage usually happens when the ceramic pot is not gently

handled or can occur when it is lifted out of the safe storage container while it is filled

with water, then the weight can be enough to break off the lip. Breaking the lip does

not always destroy the pot, but it does create a gap between the ring lid and the

ceramic filter, allowing unfiltered water to contaminate the filtered water inside the

safe storage container; lip breakage can also create cracks in the sides of the ceramic

pot, making it useless as it will no longer effectively filter the water.

5% of all breakage occurs with the plastic safe storage container. To allow the tap to fit

in, the plastic container has been perforated. It is this perforation that forms the

weakest spot of the safe storage container. If during the installation, the tap istightened too hard in the perforation of the storage container, there is a chance that

the plastic of the container cracks and as a result starts leaking water.

Leakage

Leakage usually occurs when the tap is incorrectly inserted in the perforation of the

safe storage container. As described above, some filters may start leaking when a

heavy-handed tap installation results in a cracked container; although most filters start

leaking because of incorrectly or incompletely installed tap washers. Washers are two

rubber rings that closely secure the tap in the plastic safe storage container; they are

specifically made to prevent leakage, but if incorrectly installed, they may be the cause

of leakage.

(ii) Access to improved water sources

Clearly the main reason why households stop using the ceramic filter, is the access to

an improved water source such as a borehole, a protected hand dug well or pipe

water; or the availability of rain water during the wet season. Improved water sources

may be temporarily inaccessible due to contamination as a result of a natural disaster

or malfunction; once they are restored to their useful condition, households will revisit

them as their most preferred source of drinking water. Some households have

installed primitive rainwater harvesting systems in their compound. With the arrival of

the wet season, many of these households decided to stop using their ceramic filters,

at least temporarily and unfortunately some permanently, preferring to consume the

untreated rain water. Naturally, water that originates from such rain water sources

usually appears clean to the eye, easily convincing the beneficiary that further

treatment is pointless.


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soon advise its ceramic pot manufacturer to make the lip of the ceramic filter

considerably stronger by increasing the thickness from to . In cooperation with

the manufacturer of the plastic container, PHW is also investigating how to make the

safe storage container more durable.

As the different elements of the Kosim ceramic filter are supplied by various

manufacturers, sporadically it happens that one or more elements do not meet the

prescribed quality standards, sometimes resulting in incompatible product elements

and therefore a malfunctioning ceramic filter unit. PHW has no hands-on control in the

fabrication process; although it does advise its manufacturers how to improve on each

product component. In order to guarantee end-users a quality product, PHW strives to

effectively integrate these different elements with the help of a dedicated Quality

Control Officer. This person is committed to investigate and resolve each product

anomaly in concert with the manufacturer of the part.

(ii) Access to Improved Water Sources and other reasons for discontinued use

Evidence from studies around the world have shown that access to an improved water

supply does not necessarily guarantee a safe drinking water that water can become

contaminated in transit and through unhygienic household water management and

storage practices. It is therefore important that hygienic household water

management and treatment processes become the norm for ALL households,

regardless of whether they are drinking from improved or unimproved water supplies.

If households are discontinuing the use of ceramic filters seasonally, because of the

availability of improved sources, they should be encouraged to continue their

practices of treating and safe storage of water with their Kosim ceramic pot filter. If

households are discontinuing the use of ceramic filters permanently, these filters

should be redistributed to others who can benefit.

In most cases the interviewed beneficiaries decided to stop using the ceramic filter

because they did not sufficiently realize the benefits of providing their households

with treated drinking water. Convincing them to continue to use the ceramic filter,

starts with an effective health education training, followed by monitoring and re-education visits at regular intervals, allowing Government field staff to reiterate these

benefits where deemed necessary. If trainings are successful and monitoring rounds

are properly executed, then the number of ceramic filter users is likely to be

significantly higher and more stable, then what it is now, even in communities with

access to improved water sources.

Plan for Next Distribution: Experience has shown that the further down the delivery

chain that PHW staff are involved, the lower the breakage rates that are experienced.

This in part explains the widely varying breakage rates between individual

communities, as PHW staff may have been more or less engaged in the distribution


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and installation of filters in an individual community. For the next UNICEF distribution,

PHW will install the filter in each household, in an attempt to reduce the breakage and

leakage rates of filters. PHW staff will have spare parts on hand, so that if there is a

problem identified at the time of installation, it can be immediately corrected. In

addition, an allowance has been included in the budget for spare parts which can be

left with the local monitoring staff, so that as problems occur in the field, parts are

available to repair the filter unit or replace the broken filter pot. Finally, PHW and

government field staff training will emphasize the benefits of continuing to use filters

even on presumed safe sources of water.

Monitoring & Evaluation

Issue: In several districts, the monitoring & evaluation is not regularly (or not at all)

executed by the government field staff. As a result of this important lack of support in

the field, a large number of beneficiaries stopped using or were over time no longer

correctly using the ceramic filter unit.

Solution: It appears that the main reason why most government staff minimized its

efforts in the field is a serious lack of financial, material and human resources. For

future projects at least a part of the government expenditure for ceramic filter

monitoring should be budgeted and reimbursed. Monitoring, evaluation and re-

education are extremely important to the overall success of ceramic filter

implementation projects and should therefore be properly and regularly executed.

Plan for Next Distribution: For the next UNICEF distribution, PHW will work closely

with the government field staff in the two target districts to build their capacity for

ongoing monitoring and evaluation. In addition, UNICEF has supposedly included

funds in the district contracts to support this effort.

CONCLUSIONS

All 1001 Upper East Region households Pure Home Water assessed over the three

month monitoring period from June to August 2008 were identified by GPS

coordinates and all villages receiving filters were mapped. PHW found that 64% of

filters were still in use after 3 to 6 months: 12% (in aggregate, but with a range of 5%

to 45%) of ceramic filters were no longer in use because of a malfunctioning filter and

24% because of resumed access to improved water sources. A scoring system rated

the success of both the District Government and the community roles, covering each

project phase: distribution, training and education, treatment and maintenance,

monitoring and re-education, appreciation. Each theme was scored in each

community and recommendations for improvement in future distributions were

communicated to UNICEF and posted on-line at:

http://web.mit.edu/watsan/meng_ghana/html


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LIST OF ABBREVIATIONS

Community Water and Sanitation Agency CWSA

Household drinking water treatment and safe storage HWTS

Kassena Nankana District Assembly KNDA

Pure Home Water PHW

Regional Environmental Health and Sanitation Units EHSU

REFERENCES

Johnson, S. Health and Water Quality Monitoring of Pure Home Waters Ceramic Filter

Dissemination in the Northern Region of Ghana. Massachusetts Institute of

Technology, Civil and Environmental Engineering Dept., Master of Engineering Thesis.

June 2007. http://web.mit.edu/watsan/project_ghana.htm

WSP/UNICEF. Use of Ceramic Water Filters in Cambodia. Field Note. August, 2007

wef09 talk -desmyster at al, monitoring and evaluation of 1,000 households receiving ceramic pot...

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