Public Health Infrastructure in
Crisis - Surveillance, Sanitation
and Shelter Based Care
INTRODUCTION
• Communities affected by a disaster often lack basic water and sanitation facilities. They are likely
to be traumatized and vulnerable to water related disease.
• Disruption of familiar practices/Relocation to new environments: Deterioration in existing hygiene
behaviors.
The SPHERE
• Created in 1997
• Group of humanitarian NGOs, the Red Cross and Red Crescent
Movement.
• Aims to improve the quality of humanitarian responses and to be
accountable for their actions.
Objectives
The main objective of WASH programmes in humanitarian response is to reduce
public health risks by blocking the major pathways of spread of disease by:
• promoting good hygiene practices;
• providing safe drinking water;
• providing appropriate sanitation facilities;
• reducing environmental health risks; and
• ensuring conditions that allow people to live with good health, dignity, comfort and safety.
WASH standards
Hygiene Promotion Excreta management Solid waste
management
Water supply
Vector control Outbreak and
healthcare settings`
WaSH related diseases -
• Water-borne diseases: Dairrheal illness, Enteric fever, etc
• Water-washed diseases: Caused by inadequate use of water for domestic
and personal hygiene (scabies)
• Water-based diseases: Infections caused by parasites usually found in
aquatic organisms, for example schistosomiasis, stronglyoidiasis.
• Water-related diseases: Insect vectors, breeding or living in or around
water.
Hygiene promotion
Promoting positive behavior Identification, access and use
of hygiene items
Menstrual hygiene
Principles of hygiene promotion
1. Identify the main public health risks and the current hygiene practices that contribute to
these risks.
2. Target specific audiences especially children, pregnant female, elderly.
3. Initially target small number of risk reduction practices like hand hygiene.
4. Identify the best way to communicate.
5. Use a cost-effective mix of communication channels( Mass media/ graphical/audiovisual
methods)
6. Initially target small number of risk reduction practices like hand hygiene.
Activities for positive hygiene
behavior
• Community mobilization: Two outreach workers per 1,000 people
• Working with children
• Communication channels and community dialogues
• Promoting the use of toilets
• Collecting, transporting and storing drinking water
• Involving people on the move
• Handwashing with soap with demonstrations in displaced facilities
Identification, access to and use of
hygiene items
• Identify the essential hygiene items that individuals, households and
communities need
• Adequate size of water containers per household(depends on nature
of water supply)
• Market-based programming for hygiene items( VOCAL FOR LOCAL)
• Set up a dedicated distribution team (countering any possible
discrimination)
• Standardised kits for people on the move
Addressing menstrual hygiene
management and incontinence in
crises
• Dedicated container with lid, Rope and pegs for drying
• Absorbent cotton material (4 m2 per year)
• Disposable pads (15 per month)
• Reusable sanitary pads (6 /year)
• Underwear (6/ year)
• Extra soap (250 grams per month)
• Bleach/ similar disinfectant cleaning product (3 litres of nondiluted
product/year)
• Bed pan and urinal bottles (male and female), toilet commode chair
Water supply
1. Identify the most appropriate groundwater or surface water sources, taking
account of potential environmental impacts.
2. Determine how much water is required and the systems needed to deliver it.
3. Determine how much water is required and the systems needed to deliver it.
4. Ensure appropriate waterpoint drainage at household and communal levels.
Water source selection
SUSTAINABILITY(
<5% buying
AVAILAIBILITY(8
water for basic
hrs/day)
facilities,< 3-5%
• 250 people per tap of income)
• 500 people per hand pump
• 400 people per open hand well
• 100 people per laundry facility
• 50 people per bathing facility
PROXIMITY(<500 m SAFETY(preferably
of household, <30 treated
mins queue) groundwater
facilities)
NEEDS QUANTITY (LITRES/PERSON/DAY) ADAPT TO CONTEXT BASED ON
Survival: food and drinking water 2.5-3 Climate and individual physiology
Hygiene practices 2-6 Societal and cultural norms
Food type and social and cultural
Basic cooking 3-6
norms
Total basic water 7.5-15
5 (per outpatient)
Health centers and hospitals 40-60 (per inpatient) Laundry, equipments, flushing etc
100 (per surgery/ delivery)
Cholera centers 60
1-2 (handwashing)
Public toilets
2-8 (cleaning)
Mobile clinics 1-5
Standards of water supply and
surveillance
• Sanitary survey of the waterpoint
• Observation of use of separate
containers for collection/storage
• Observation of clean, covered
drinking water containers
• Water quality testing
• Filtration techniques
• Post-delivery contamination
• Household level water treatment
Filtration Techniques
• Pressurised Sand Filters
• Used for emergencies.
• These are combined with coagulation and flocculation processes,
along with activated carbon and chlorination.
• Deployed via mobile water treatment units
• Have high capital and operation costs
• Require skilled operators, output between 3 to 5000 litres per
hour.
• Slow Sand Filters
• These are more applicable in longer-term emergencies
• Their setup requires a raw water tank, floating outlet, and
roughing filter before hooking it up to the slow sand filter.
• Membrane filters
• Water is passed through the membrane at low pressure.
• These membranes have a pore size of around 100 nm
• Turbidity will be reduced to about 0.1 NTU.
• Simple Household Filtration technique: Cotton Cloth
• Straining water through a piece of fine, cotton cloth is able to
remove some of the suspended solids and insect larvae from the
water.
• This had some results in Bangladesh according to Unicef (Page 99)
: “In Bangladesh, folding a cotton cloth in four and straining water
through that, reduced the cholera bacilli by 90% and in the
villages where this was promoted, cholera rates reduced by 50%
Excreta Management
• Establish defaecation areas, site and build communal toilets, and start a
concerted hygiene campaign
• 30 m from water source and 1.5 m above groundwater level
• Ratio of shared toilets (Minimum 1 per 20 people)
• Distance between dwelling and shared toilet (Maximum 50 metres)
• Toilets having internal locking, adequate lighting and safe for women
Excreta Disposal
DESLUDGING
It is the removal of (untreated and partially treated) excreta from the pit, vault or tank, and transport
to an off-site treatment and disposal facility.
Sullage or domestic wastewater is classified as sewage when mixed with human excreta. Unless the
settlement is sited where there is an existing sewerage system, domestic wastewater should not be
allowed to mix with human excreta. Sewage is difficult and more expensive to treat than domestic
wastewater.
Excreta as Resource
Excreta Processed sludge Energy (Compost) Soil conditioner/ Fertiliser
VECTOR CONTROL
I. Assessment of risk factors (eg: large breeding sites such as swamps and lakes, immunity status
of population, pathogen type and prevalence, settlement pattern, shelter type, individual
protection and avoidance meaures)
II. Removing/modifying vector breeding and feeding sites – Eliminating stagnant water, managing
excreta and solid wastes, sealing off-seat toilet pits, providing lids on containers, larvicide
treatments in endemic areas
III. Key Indicators - Percentage of people who have taken appropriate action to protect
themselves, Percentage of households with adequate protection for stored food
WASH Principles in Disease
Outbreaks
WASH in Healthcare Settings -
1. Store at least 48 hours’ worth of safe water (0.5mg/l free residual chlorine)
2. Provide sufficient excreta disposal facilities to limit disease transmission.
3. For outbreaks: Provide excreta disposal facilities in each zone of the
healthcare, adapt materials and supplies for the specific disease, such as
cholera beds and excreta or vomitus buckets
4. Set up additional hygiene practices, such as chlorine foot baths or spraying
and handwashing before putting on or removing personal protective
equipment
Emergency Water Supply
