Safe Water Comes to India

PSI has just launched a new safe water system (SWS) in India called Safewat that is unique in its attempt to focus on water quality and hygiene. In addition to disinfecting water, the India initiative also promotes such hygiene measures as hand-washing and protecting food from flies.

Orissa: The First State Launch
BHUBANESHWAR, Orissa, India–PSI launched SWS under the brand name Safewat on May 31 here in the capital city of Orissa State (population 36.7 million). Orissa has serious water quality issues–a combination of frequent natural disasters, such as floods and cyclones and low awareness of water quality issues and the link between contaminated water and diarrhea. The Orissa National Family Health Survey (1998-99) reports that 80% of households in Orissa do not purify water. Twenty eight percent of children under three suffer from diarrhea and 35% of these sick children did not receive any treatment at all.

The Safewat launch began with a participatory training session for the Orissa sales force on diarrheal diseases and linkages to other maternal and child health issues, local issues of water quality, the rationale for a home-based safe drinking water intervention, and product-related information such as features and benefits, promotional materials, and planned communications activities.

The group then broke up into smaller teams, and visited chemist and non-traditional outlets to get their "hands dirty". They used the selling story developed during a participatory session. Out of a total of 95 outlets visited, 72 were successful: A total of 514 bottles of Safewat disinfectant, and 19 Safewat vessels, were sold. Since then, field officers have received orders from stockists in all major towns. Branded and generic TV spots addressing safe water storage and treatment will be aired from July onwards.

The Delhi Pilot
DELHI, India–PSI and the World Health Organization (WHO) are partnering to implement a community-based SWS pilot intervention to reduce diarrheal diseases in twelve urban slums of West Delhi. The two-year pilot covers a population of approximately 150,000 and will run until September 2003. The WHO has provided funding, and PSI is creating access to the disinfectant and vessel and the development of a behavior change communications strategy.

Behavior change messages address a few easily actionable and relevant practices or behaviors. The primary targets for these messages are the parents of children under the age of five. The desired behavior changes that are part of the communications strategy to reduce diarrheal disease in the pilot population are:

•	Consumption of safe water by all family members by regularly using the SWS to treat water and store it safely.
•	Adoption of hygienic practices that impact on water and food safety, in particular:
	•	Hand washing
	•	Clean food preparation
	•	Clean toilet habits, including sanitary disposal of feces
	•	Proper garbage disposal
•	Continuation of practices known to play a protective/beneficial role:
	•	exclusive breastfeeding
	•	vaccination against all vaccine-preventable diseases, including measles
	•	increased feeding for up to two weeks following a diarrheal episode

A partner grassroots NGO, Sulabh International Institute of Health and Hygiene, is providing on-the-ground support. Sulabh was invited to partner with PSI and WHO for several reasons: they have built and currently operate six public toilets in the pilot area, have a strong presence in the area, and have provided training to over 6,000 residents of Delhi slums on hygiene and sanitation-related issues.

Pilot partners have identified 1,500 change agents, themselves residents of the target slums, to carry out interpersonal communication activities in these slums. To ensure sustainability, these volunteers will sell the SWS vessel and disinfectant, and thus earn a margin on each sale. The change agents' inter-personal communication activities will be supported by generic and brand-related communications through mobile video units, theater groups, school-based activities, and promotional materials at retail outlets selling the disinfectant and vessel.

PSI has begun placing SWS products at retail outlets in the pilot area, to ensure availability once change agents start creating demand. All IEC materials have been developed and produced, and a TV spot is currently being produced. Training of change agents is scheduled to begin in the first week of July, and pilot activities will begin by the last week of July.

The Scope of the Problem
While access to drinking water in India has increased over the past decade, the tremendous adverse impact of unsafe water on health continues. Diarrhea killed over 700,000 Indians in 1999 -over 1,600 deaths each day. Most diarrheal disease deaths occur in children under the age of five.

Why do these deaths continue, even with access to safe sources of water increasing each year? There are several reasons. Many low-income communities in India and other developing countries continue to lack access to proper sanitation and sewage systems, garbage collection networks, and information and education on hygiene and sanitation. Important routes of entry of diarrhea-causing germs are through cracks in piped water delivery systems, and through widespread unhygienic practices during water collection, storage and use. Poor hand washing and limited access to sanitation facilities perpetuate the transmission of diarrhea-causing germs from feces into the mouth.

The SWS, an effective and affordable intervention to provide safe drinking water, was developed by the Centers for Disease Control and Prevention and the Pan American Health Organization. The basis of the SWS intervention is:

•	Point-of-use treatment of contaminated water with locally produced sodium hypochlorite solution, packaged in locally available bottles with a cap that serves as a dosing device.
•	Safe water storage in plastic containers with a covered narrow mouth and a spigot to prevent recontamination.
•	Behavior change techniques, including social marketing, community mobilization, and innovative information, education and communication.

In the past year, PSI, WHO and CDC have worked closely to promote the safe water system in southeast Asia and India in particular. CDC has provided ongoing technical advice from the feasibility assessment stage, and Dr. Robert Quick from the Foodborne and Diarrheal Diseases Branch was present in Delhi during the final stages of product development and provided critical information around dosing and pilot design. Proctor & Gamble, USA provided blueprints of the vessel mold, which greatly facilitated local mold design and production of vessels of a quality comparable with the original P&G vessels.

Future Plans
Subsequent to the Orissa and Delhi launches, PSI will begin to social market Safewat in Rajasthan by the end of July, and rapidly take the SWS to additional Indian states. Through information, education and communication activities and the creation of access to the SWS disinfectant and vessel, PSI aims to effect a reduction in diarrhea-related morbidity and mortality among the residents of slums and other under-served populations. PSI also hopes to share lessons learned from this pilot widely with other interested organizations.

–Dr. Krishna Jafa, New Business Development Manager, PSI/India

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PSI/India's Safewat safe water system brings an effective, affordable solution to parts of India plagued by dangerously poor water quality. PSI/India is the third PSI program to market a safe water system.