Preventive management is the preferred approach to ensuring drinking-water safety and should take account of the characteristics of the drinking-water supply from catchment and source to its use by consumers. As many aspects of drinking-water quality management are often outside the direct responsibility of the water supplier, it is essential that a collaborative multiagency approach be adopted to ensure that agencies with responsibility for specific areas within the water cycle are involved in the management of water quality.
A preventive integrated management approach with collaboration from all relevant agencies is the preferred approach to ensuring drinking-water safety. (WHO)
One example is where catchments and source waters are beyond the drinking-water supplier’s jurisdiction. Consultation with other authorities will generally be necessary for other elements of drinking-water quality management, such as monitoring and reporting requirements, emergency response plans and communication strategies.
Major stakeholders that could affect or be affected by decisions or activities of the drinking-water supplier should be encouraged to coordinate their planning and management activities where appropriate. These could include, for example, health and resource management agencies, consumers, industry and plumbers. Appropriate mechanisms and documentation should be established for stakeholder commitment and involvement.
Surveillance And Quality Control
In order to protect public health, a dual-role approach, differentiating the roles and responsibilities of service providers from those of an authority responsible for independent oversight protective of public health (“drinking-water supply surveillance”), has proven to be effective.
Drinking-water suppliers are responsible at all times for the quality and safety of the water that they produce. (WHO)
Organizational arrangements for the maintenance and improvement of drinking water supply services should therefore take into account the vital and complementary roles of the agency respon sible for surveillance and of the water supplier. The two functions of surveillance and quality control are best performed by separate and independent entities because of the conflict of interest that arises when the two are combined. In this:
- national agencies provide a framework of targets, standards and legislation to enable and require suppliers to meet defined obligations;
- agencies involved in supplying water for consumption by any means should be required to ensure and verify that the systems they administer are capable of delivering safe water and that they routinely achieve this;
- a surveillance agency is responsible for independent (external) surveillance through periodic audit of all aspects of safety and/or verification testing.
In practice, there may not always be a clear division of responsibilities between the surveillance and drinking-water supply agencies. In some cases, the range of professional, governmental, nongovernmental and private institutions may be wider and more complex than that discussed above. Whatever the existing framework, it is important that clear strategies and structures be developed for implementing water safety plans, quality control and surveillance, collating and summarizing data, reporting and disseminating the findings and taking remedial action. Clear lines of accountability and communication are essential.
Surveillance is an investigative activity undertaken to identify and evaluate potential health risks associated with drinking water. Surveillance contributes to the protection of public health by promoting improvement of the quality, quantity, accessibility, coverage (i.e. populations with reliable access), affordability and continuity of drinking-water supplies (termed “service indicators”). The surveillance authority must have the authority to determine whether a water supplier is fulfilling its obligations.
Surveillance of drinking-water quality can be defined as “the continuous and vigilant public health assessment and review of the safety and acceptability of drinking-water supplies” (WHO, 1976).
In most countries, the agency responsible for the surveillance of drinking-water supply services is the ministry of health (or public health) and its regional or departmental offices. In some countries, it may be an environmental protection agency; in others, the environmental health departments of local government may have some responsibility.
Surveillance requires a systematic programme of surveys, which may include auditing, analysis, sanitary inspection and institutional and community aspects. It should cover the whole of the drinking-water system, including sources and activities in the catchment, transmission infrastructure, treatment plants, storage reservoirs and distribution systems (whether piped or unpiped).
Ensuring timely action to prevent problems and ensure the correction of faults should be one aim of a surveillance programme. There may at times be a need for penalties to encourage and ensure compliance. The surveillance agency must therefore be supported by strong and enforceable legislation. However, it is important that the agency develops a positive and supportive relationship with suppliers, with the application of penalties used as a last resort.
The surveillance agency should be empowered by law to compel water suppliers to recommend the boiling of water or other measures when microbial contamination that could threaten public health is detected.
Public Health Authorities
In order to effectively support the protection of public health, a national entity with responsibility for public health will normally act in four areas:
- surveillance of health status and trends, including outbreak detection and investigation, generally directly but in some instances through a decentralized body;
- directly establishing drinking-water norms and standards. National public health authorities often have the primary responsibility for setting norms on drinking water supply, which may include the setting of water quality targets, performance and safety targets and directly specified requirements (e.g. treatment). Normative activity is not restricted to water quality but also includes, for example, regulation and approval of materials and chemicals used in the production and distribution of drinking-water and establishing minimum standards in areas such as domestic plumbing. Nor is it a static activity, because as changes occur in drinking-water supply practice, in technologies and in materials available (e.g. in plumbing materials and treatment processes), so health priorities and responses to them will also change;
- representing health concerns in wider policy development, especially health policy and integrated water resource management. Health concerns will often suggest a supportive role towards resource allocation to those concerned with drinking water supply extension and improvement, will often involve lobbying for the primary requirement to satisfy drinking-water needs above other priorities and may imply involvement in conflict resolution;
- direct action, generally through subsidiary bodies (e.g. regional and local environmental health administrations) or by providing guidance to other local entities (e.g. local government) in surveillance of drinking-water supplies. These roles vary widely according to national and local structures and responsibilities and frequently include a supportive role to community suppliers, where local authorities often intervene directly.
Public health surveillance (i.e. surveillance of health status and trends) contributes to verifying drinking-water safety. It takes into consideration disease in the entire population, which may be exposed to pathogenic microorganisms from a range of sources, not only drinking-water. National public health authorities may also undertake or direct research to evaluate the role of water as a risk factor in disease, through case–control, cohort or intervention studies, for example. Public health surveillance teams typically operate at national, regional and local levels, as well as in cities and rural health centres. Routine surveillance includes:
- ongoing monitoring of reportable diseases, many of which can be caused by waterborne pathogens;
- outbreak detection;
- long-term trend analysis;
- geographic and demographic analysis;
- eedback to water authorities.
Public health surveillance can be enhanced in a variety of ways to identify possible waterborne outbreaks in response to suspicion about unusual disease incidence or following deterioration of,water quality. Epidemiological investigations include:
- outbreak investigations;
- intervention studies to evaluate intervention options;
- case–control or cohort studies to evaluate the role of water as a risk factor in disease.
However, public health surveillance cannot be relied upon to provide information in a timely manner to enable short-term operational response to control water borne disease. Limitations include:
- outbreaks of non-reportable disease;
- time delay between exposure and illness;
- time delay between illness and reporting;
- low level of reporting;
- difficulties in identifying causative pathogens and sources.
The public health authority operates reactively, as well as proactively, against the background of overall public health policy and in interaction with all stakeholders. In accounting for public health context, priority will normally be afforded to disadvantaged groups. This will generally entail balancing drinking-water safety management and improvement with the need to ensure access to reliable supplies of safe drinking water in adequate quantities.
In order to develop an understanding of the national drinking-water situation, the national public health authority should periodically produce reports outlining the
state of national water quality and highlighting public health concerns and priorities in the context of overall public health priorities. This implies the need for effective exchange of information between local, regional and national agencies. National health authorities should lead or participate in the formulation and implementation of policy to ensure access to some form of reliable, safe drinking-water supply. Where this has not been achieved, appropriate tools and education should be made available to implement individual or household-level treatment and safe storage.
Local environmental health authorities often play an important role in managing water resources and drinking-water supplies. This may include catchment inspection and authorization of activities in the catchment that may have an impact on source water quality.
It can also include verifying and auditing (surveillance) of the management of formal drinking-water systems. Local environmental health authorities will also give specific guidance to communities or individuals in designing and implementing community and household drinking-water systems and correcting deficiencies, and they may also be responsible for surveillance of community and household drinking-water supplies.
They have an important role to play in educating consumers where household water treatment is necessary. Management of household and small community drinking-water supplies generally requires education programmes about drinking-water supply and water quality. Such programmes should normally include:
- water hygiene awareness raising;
- basic technical training and technology transfer in drinking-water supply and management;
- consideration of and approaches to overcoming sociocultural barriers to acceptance of water quality interventions;
- motivation, mobilization and social marketing activities;
- a system of continued support, follow-up and dissemination of the water quality programme to achieve and maintain sustainability.
These programmes can be administered at the community level by local health authorities or other entities, such as nongovernmental organizations and the private sector. If the programme arises from other entities, the involvement of the local health authority in the development and implementation of the water quality education and training programme is strongly encouraged. Approaches to participatory hygiene and sanitation education and training programmes are described in other WHO documents (see Simpson-Hébert, Sawyer & Clarke, 1996; Sawyer, Simpson-Hébert & Wood, 1998; Brikké, 2000).
Water resource management
Water resource management is an integral aspect of the preventive management of drinking-water quality. Prevention of microbial and chemical contamination of source water is the first barrier against drinking-water contamination of public health concern.
Water resource management and potentially polluting human activity in the catchment will influence water quality downstream and in aquifers. This will have an impact on the treatment steps required to ensure safe water, and preventive action may be preferable to upgrading treatment.
The influence of land use on water quality should be assessed as part of water resource management. This assessment is not normally undertaken by health authorities or drinking-water supply agencies alone and should take into consideration:
land cover modification;
- extraction activities;
- construction/modification of waterways;
- application of fertilizers, herbicides, pesticides and other chemicals;
- livestock density and application of manure;
- road construction, maintenance and use;
- various forms of recreation;
- urban or rural residential development, with particular attention to excreta disposal, sanitation, landfill and waste disposal;
- other potentially polluting human activities, such as industry, mining and military sites.
Water resource management may be the responsibility of catchment management agencies and/or other entities controlling or affecting water resources, such as industrial, agricultural, navigation and flood control entities.
The extent to which the responsibilities of health or drinking-water supply agencies include water resource management varies greatly between countries and communities. Regardless of government structures and sector responsibilities, it is important that health authorities liaise and collaborate with sectors managing the water resource and regulating land use in the catchment.
Establishing close collaboration between the public health authority, water supplier and resource management agency assists recognition of the health hazards potentially occurring in the system. It is also important for ensuring that the protection of drinking-water resources is considered in decisions for land use or regulations to control contamination of water resources. Depending on the setting, this may include involvement of further sectors, such as agriculture, traffic, tourism or urban development.
To ensure the adequate protection of drinking-water sources, national authorities will normally interact with other sectors in formulating national policy for integrated water resource management. Regional and local structures for implementing the policy will be set up, and national authorities will guide regional and local authorities by providing tools.
Regional environmental or public health authorities have an important task in participating in the preparation of integrated water resource management plans to ensure the best available drinking-water source quality. For further information, see the supporting document Protecting groundwater for health.
Drinking-water supply agencies
Drinking-water supplies vary from very large urban systems servicing large populations with tens of millions of people to small community systems providing water to very small populations. In most countries, they include community sources as well as piped means of supply.
Drinking-water supply agencies are responsible for quality assurance and quality control. Their key responsibilities are to prepare and implement water safety plans. In many cases, the water supplier is not responsible for the management of the catchment feeding the sources of its supplies.
The roles of the water supplier with respect to catchments are to participate in interagency water resource management activities, to understand the risks arising from potentially contaminating activities and incidents and to use this information in assessing risks to the drinking-water supply and developing and applying appropriate management.
Although drinking-water suppliers may not undertake catchment surveys and pollution risk assessment alone, their role is to recognize the need for them and to initiate multiagency collaboration for example, with health and environmental authorities.
Experience has shown that an association of stakeholders in drinking-water supply (e.g. operators, managers and specialist groups such as small suppliers, scientists, sociologists, legislators and politicians) can provide a valuable non-threatening forum for the interchange of ideas. For further information, see the supporting document Water safety plans.
Community-managed drinking-water systems, with both piped and non-piped distribution, are common worldwide in both developed and developing countries. The precise definition of a community drinking-water system will vary. Although a definition
based on population size or the type of supply may be appropriate under many conditions, approaches to administration and management provide a distinction between the drinking-water systems of small communities and those of larger towns and cities.
This includes the increased reliance on often untrained and sometimes unpaid community members in the administration and operation of community drinking-water systems. Drinking-water systems in periurban areas the communities surrounding major towns and cities in developing countries may also have the characteristics of community systems.
Effective and sustainable programmes for the management of community drinking-water quality require the active support and involvement of local communities.
These communities should be involved at all stages of such programmes, including initial surveys; decisions on siting of wells, siting of intakes or establishing protection zones; monitoring and surveillance of drinking-water supplies; reporting faults,
carrying out maintenance and taking remedial action; and supportive actions, including sanitation and hygiene practices. A community may already be highly organized and taking action on health or
drinking-water supply issues. Alternatively, it may lack a well-developed drinking water system; some sectors of the community, such as women, may be poorly represented; and there may be disagreements or factional conflicts.
In these situations, achieving community participation will take more time and effort to bring people together, resolve differences, agree on common aims and take action. Visits, possibly over several years, will often be needed to provide support and encouragement and to ensure that the structures created for safe drinking-water supply continue to operate. This may involve setting up hygiene and health educational programmes to ensure that the community:
- is aware of the importance of drinking-water quality and its relationship with health and of the need for safe drinking-water in sufficient quantities for domestic use for drinking, cooking and hygiene;
- recognizes the importance of surveillance and the need for a community response;
- understands and is prepared to play its role in the surveillance process;
- has the necessary skills to perform that role;
- is aware of requirements for the protection of drinking-water supplies from pollution.
For further information, see the 1997 volume entitled Surveillance and control of community supplies (WHO, 1997); the supporting document Water safety plans(Annex 1); Simpson-Hébert, Sawyer & Clarke (1996); Sawyer, Simpson-Hébert & Wood (1998); and Brikké (2000).
Vendors selling water to households or at collection points are common in many parts of the world where scarcity of water or faults in or lack of infrastructure limits access to suitable quantities of drinking-water. Water vendors use a range of modes of transport to carry drinking-water for sale directly to the consumer, including tanker trucks and wheelbarrows or trolleys. In the context of these Guidelines, water vending does not include bottled or packaged water or water sold through vending machines.
There are a number of health concerns associated with water supplied to consumers by water vendors. These include access to adequate volumes and concern regarding inadequate treatment or transport in inappropriate containers, which can result in contamination.
More detailed information on treatment of vended water, undertaking a risk assessment of vended water supplies, operational monitoring of control measures, management plans and independent surveillance is included in section.
Everyone consumes water from one source or another, and consumers often play important roles in the collection, treatment and storage of water. Consumer actions may help to ensure the safety of the water they consume and may also contribute to improvement or contamination of the water consumed by others. Consumers have the responsibility for ensuring that their actions do not have an adverse impact on water quality.
Installation and maintenance of household plumbing systems should be undertaken preferably by qualified and authorized plumbers or other persons with appropriate expertise to ensure that cross-connections or backflow events do not result in contamination of local water supplies.
In most countries, there are populations whose water is derived from household sources, such as private wells and rainwater. In households using non-piped water supplies, appropriate efforts are needed to ensure safe collection, storage and perhaps treatment of their drinking-water. In some circumstances, households and individuals may wish to treat water in the home to increase their confidence in its safety.
This would be relevant where community supplies are absent or where community supplies are known to be contaminated or causing waterborne disease. Public health surveillance or other local authorities may provide guidance to support households and individual consumers in ensuring the safety of their drinking-water. Such guidance is best provided in the context of a community education and training programme.
Certification is used to verify that devices and materials used in the drinking-water supply meet a given level of quality and safety. Certification is a process in which an independent organization validates the claims of the manufacturers against a formal standard or criterion or provides an independent assessment of possible risks of contamination from a material or process. The certification agency may be responsible for seeking data from manufacturers, generating test results, conducting inspections and audits and possibly making recommendations on product performance.
Certification has been applied to technologies used at household and community levels, such as hand pumps; materials used by water supplies, such as treatment chemicals; and devices used in the household for collection, treatment and storage.
Certification of products or processes involved in the collection, treatment, storage and distribution of water can be overseen by government agencies or private organizations. Certification procedures will depend on the standards against which the products are certified, certification criteria and the party that performs the certification.
Certification can also be applied to the implementation of water safety plans. This can take the form of an independent organization or party undertaking audits to verify that plans have been properly designed, are being implemented correctly and are effective.
National, local government or private (third-party auditing) certification programmes have a number of possible objectives:
- certification of products to ensure that their use does not threaten the safety of the user or the general public, such as by causing contamination of drinking water with toxic substances, substances that could affect consumer acceptability or substances that support the growth of microorganisms;
- product testing, to avoid retesting at local levels or prior to each procurement;
- ensuring uniform quality and condition of products;
- certification and accreditation of analytical and other testing laboratories;
- control of materials and chemicals used for the treatment of drinking-water, including the performance of devices for household use;
- ensuring that water safety plans are effective.
An important step in any certification procedure is the establishment of standards, which must form the basis of assessment of the products. These standards should also as far as possible contain the criteria for approval. In procedures for certification on technical aspects, these standards are generally developed in cooperation with the manufacturers, the certifying agency and the consumers. The national public health authorities should have responsibility for developing the parts of the approval process or criteria relating directly to public health. For further information on the control of materials and chemicals used for the treatment of drinking-water.
Significant adverse health effects have been associated with inadequate plumbing systems within public and private buildings arising from poor design, incorrect installation, alterations and inadequate maintenance.
Numerous factors influence the quality of water within a building’s piped distribution system and may result in microbial or chemical contamination of drinking water. Outbreaks of gastrointestinal disease can occur through faecal contamination of drinking-water within buildings arising from deficiencies in roof storage tanks and cross-connections with wastewater pipes, for example.
Poorly designed plumbing systems can cause stagnation of water and provide a suitable environment for the proliferation of Legionella. Plumbing materials, pipes, fittings and coatings can result in elevated heavy metal (e.g. lead) concentrations in drinking-water, and inappropriate materials can be conducive to bacterial growth. Potential adverse health effects may not be confined to the individual building. Exposure of other consumers to contaminants is possible through contamination of the local public distribution system, beyond the particular building, through cross-contamination of drinking-water and backflow.
The delivery of water that complies with relevant standards within buildings generally relies on a plumbing system that is not directly managed by the water supplier.
Reliance is therefore placed on proper installation of plumbing and, for larger buildings, on building specific water safety plans.
To ensure the safety of drinking-water supplies within the building system, plumbing practices must prevent the introduction of hazards to health. This can be achieved by ensuring that:
- pipes carrying either water or wastes are watertight, durable, of smooth and unobstructed interior and protected against anticipated stresses;
- cross-connections between the drinking-water supply and the wastewater removal systems do not occur;
- roof storage systems are intact and not subject to intrusion of microbial or chemical contaminants;
- hot and cold water systems are designed to minimize the proliferation of Legionella
- appropriate protection is in place to prevent backflow;
- the system design of multistorey buildings minimizes pressure fluctuations;
- waste is discharged without contaminating drinking-water;
- plumbing systems function efficiently
It is important that plumbers are appropriately qualified, have the competence to undertake necessary servicing of plumbing systems to ensure compliance with local regulations and use only materials approved as safe for use with drinking water.
Design of the plumbing systems of new buildings should normally be approved prior to construction and be inspected by an appropriate regulatory body during construction and prior to commissioning of the buildings.
For more information on the essential roles of proper drinking-water system and waste system plumbing in public health, see the supporting document Health aspects of plumbing.