Pure Home Water manual

PURE HOME WATER’S SOCIAL BUSINESS: DISSEMINATING CERAMIC WATER FILTERS & BUILDING A CERAMIC FILTER FACTORY IN NORTHERN GHANA

Susan MurcottSr. Lecturer, MITFounder, Pure Home Water

Brandeis University, Heller School, Lunch Talk, Friday, March 12, 2010

Global Situation

1.8 million children die each year from diarrheal diseases, which kills more children than AIDS, malaria and measles combined.

In recent years, awareness and funding directed towards reducing disease and death from diarrhea have been insufficient to address the enormous disease burden… it has been an “invisible” problem, mostly affecting poor women and children.

Lower Respiratory Infections

HIV/AIDS DiarrhoealDiseases

Tuberculosis Malaria Measles

Over age 5

Under age 5

De

ath

s i

n m

illi

on

s

Source: WHO 2004

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0 3.9

2.8

1.8

1.6

1.3

0.6

Leading Infectious Killers - 2002

WHO, Preventing Disease…, 2006, p. 62.

Among children 0 – 14 years, the proportion of deaths attributed to the environment is 36%.

Main Diseases Contributing to the Environmental Burden of Disease, Among Children 0-14 years

Children Under 5 Years- Mortality

Outline of Questions Addressed What has Pure Home Water (PHW) done

to save lives from water-related diseases?

What will PHW do to save lives? How many lives can PHW save? On what basis, scientific, past

experience, etc. does PHW believe these many lives can be saved?

How many dollars does PHW need to accomplish this objective?

What has Pure Home Water done…

…to save lives?

Pure Home Water- Ghana

Pure Home Water (PHW) is a social enterprise founded in 2005 by MIT Senior Lecturer, Susan Murcott, with Ghanaian partners, to provide safe drinking water via ceramic pot filters.

PHW has 2 goals:

1. Reach people most in need of safe drinking water in Northern Ghana, the poorest part of Ghana

2. Become financially and locally self-sustaining

Village women training in filter use

Pure Home Water (2005-2009) has:

Sold over 12,000 filters and reached over 100,000 people with ceramic pot (Kosim) filters, through direct sales and emergency distributions (flood, guinea worm outbreak)

Developed educational materials and a trainer’s manual on filter use

Provided water/sanitation/hygiene trainings to > 1,000 communities, groups and individual users.

Established an office, training center, water quality laboratory and guest house.

Provided employment to > 20 Ghanaians.

Kosim is a word in the

local Ghanaian Dagbani

language, meaning

“pure water”

Pure Home Water (2005-2009) has:

Pure Home Water Filter Sales(2005 – 2009)

0

1000

2000

3000

4000

5000

6000

7000

8000

Yr 1 (0506) Yr 2 (0607) Yr 3 (0708) FY 4 (0809)

5691,224

333retail sales

7,700 flood sales

2,531 emergency distribution

371 retail sales

Pure Home Water (2005-2009) has:

Procured, distributed, trained users, and monitored > 7,000 households during a flood emergency in Northern Ghana that affected 200,000 people.

Conducted follow-up monitoring of over 2,000 users, many in remote rural areas, in-home service and re-education of users on filter operation and maintenance

Hosted MIT teams to provide special assistance to local partners in R&D and business.

Begun construction and manufactured its first locally-produced filters at the Phase 1 factory site in Taha, Ghana

Filter distribution during floods

Monitoring results from flood filters

2009 Guinea Worm Distribution

2000 Filters: Training, Dissemination & Monitoring

Woman from Yesapi, Central Gonja, with bandage covering guinea worm- infected foot

…planning to do to save lives?

What is Pure Home Water…

Pure Home Water Current and Future Plans (2010 – 2015) Reach 1 million people in

Northern Ghana with ceramic pot (Kosim) filters

Complete Phase 2 construction of a ceramic filter factory in Taha Ghana (Phase I completion done by Jan. 2010.)

Improve filter design and quality control of process variables.

Complete all construction in 2011 (Phase 3: residential/guest building)

Become financially self-sustaining

How many lives can we save?

Credit: Alexandr Nishichenko

Childhood Mortality Stats

Ghana’s average childhood mortality is 112 deaths / 1000 live births

There are significant North/South differences The majority of Northern Region and the Upper West both have >155 deaths / 1000 live births.

Africa’s rate is 167 deaths / 1000 live births.

(http://www.afro.who.int/home/countries/fact_sheets/ghana.pdf)

Under 5 Mortality Rate / 1000 Live Births

WHO Ghana Country Fact Sheet

75-100101-127128-154155-180

>181

Background Water: 50% of people in

Northern Ghana lack access to an improved water supply

Sanitation: Ghana has the 4th worst record in the world for sanitation coverage, meaning most people in Northern Ghana practice open defecation.

This deplorable water/sanitation situation leads to a very high rate of diarrheal diseases and death, especially among children under 5 years.

Ghana is also one of the 5 remaining guinea worm endemic countries Midwife training at Pure Home Water

Office

Contaminated water supply

Improved and Unimproved Sources

Improved Sources Boreholes Household connection Public standpipe Rainwater harvesting Protected springs and

dug wells

Unimproved Sources All surface water

sources Unprotected springs

and dug wells Tanker trucks Vendor water

50% (0.9 million out of 1.8 million people) in Northern Region use an unimproved source

Northern Ghana Health Stats Upper West and Upper East, two of Pure Home

Water’s target regions, have the highest rates of diarrhea prevalence in Ghana, 27% and 21% respectively, plus guinea worm in the North..

Ghana and Guinea Worm

Ghana is one of five remaining guinea worm

endemic countries (2nd worst, after Sudan

Photo: Braimah Apambire, World Vision

Sanitation Coverage

Ghana has the 4th lowest rate of sanitation coverage in the world

Sanitation Coverage

In Pure Home Water’s region, sanitation coverage is “none” or “public” for the majority of people.... This is considered “inadequate” by U.N. definitions.

Sanitation Coverage

Latrine in the process of being built

Brick from Pure Home ceramic factory could go toward appropriate latrine construction

What scientific evidence do we have that the Kosim ceramic pot filter reduces risk of diarrhea?

Scientific Evidence

Under supervision of MIT advisor, Susan Murcott and with guidance from Harvard School of Public Health Professor Julie Bering, MIT Master of Engineering students R. Peletz (2006) and S. Johnson (2007) conducted a baseline and health impact survey in Tamale and Savelugu Districts, Northern Region, Ghana. Their goal was to find out the role of the ceramic pot filter, branded locally as the “Kosim” filter in reducing diarrheal diseases. They surveyed traditional and modern households with and without the ceramic pot filter.

Study of Impact of Ceramic Pot Filter in Northern Ghana (2006-2007) on Diarrhea

Traditional and Modern Households Surveyed

Traditional Households

(Johnson, 2007)

Modern Households (Peletz, 2006)Peletz’s sample population was 50

modern urban families in Tamale and Savelugu Districts with and without the ceramic filter.

Johnson’s sample population was 41 traditional rural families in Tamale and Savelugu Districts with and without the ceramic filter.

Peletz (2006) – Relative Risk Analysis

Peletz found that modern households with ceramic filters have 12% of the risk (88% less risk) of having diarrheal illness compared to households without filters. Results were statistically significant.

Diarrhea No Diarrhea

Filters 1 10

No Filters 18 21

Odds Ratio= (1x21) = 0.12 Statistically significant (p<.001) (18x10)

Johnson (2007)– Relative Risk Analysis

Johnson found that traditional rural households with ceramic filters have 31% of the risk (69% less risk) of having diarrheal illness compared to households without filters. Results were statistically significant.

  Diarrhea No Diarrhea

Filter 4 219

No Filter 12 203

Odds Ratio= (4x203) = 31% Statistically significant (p<0.035) (12x219)

Prior Studies on Health Impact

“Quantitative Assessment of Health Benefits of HWTS”(Nath,K.J., Bloomfield,S., and Jones,M. 2005)

“The evidence shows that provision ofsafe water alone at the household levelcan reduce diarrhoeal and other entericdiseases by 6 to 50%, even in theabsence of improved sanitation or otherhygiene measures.”

(based on literature review of 16 selected epidemiological studies of a range of HWTS options)

Differences in Study Results

Why did Peletz and Johnson have high numbers (88% less risk, 69% less risk) compared to Nath’s review of similar studies? The Peletz/Johnson sample sizes were small, limited by

time and funding constraints, which may led to a wider margin of error.

Also confounding factors, besides the filters, might have contributed to such a high % reduction among those families using the filters.

Hence, we should consider the Peletz/Johnson conclusions as preliminary.

So… how many lives do we estimate that Pure Home Water will save by building a local ceramic filter factory to reach 1 million people in Northern Ghana?

We conservatively estimate that we should be able to reduce diarrheal disease - the 2nd leading cause of death in children under 5 years in Ghana – by 25-50% among those households consistently and correctly using the Kosim ceramic pot filter

1 million people will have an improved quality of life due to reduction of diarrhea, guinea worm and other water-related diseases and deaths

Conclusion:

In addition to saving lives, why has PHW decided after 5 years to

proceed with local manufacturing?

Cost – to bring the price of the filter into reach of $1/day people

Supply Chain

Ceramica TamakloePure Home Water Office/Stockroom

PHW Truck

Bad Roads, Very Hot, Dusty Weather

District Gov’t Warehouses

Villagers

Quality Control

Breakage

Technical modifications to design and/or materials to increase durability

Design Modifications Flower Pot, Bowl or Paraboloid-

Shaped Ceramic Filter

Round bottom shape Myanmar

Standard flat-bottom shaped of flower-pot design

Paraboloid shape in Nigeria and Dominican Republic

Budget Summary:

ITEM US$

Total Estimated Budget to Construct Filter Factory $111,000

Amount spent to date on land ($10K) & construction ($33K) $43,000

Amount needed to complete Phase 2 $68,000

Ceramic Filter Factory ConstructionPhase 1 & 2

More information: Pure Home Water

http://www.purehomeh2o.org

References

• Rogers, P. Water and Child Health: An Environmental Perspective Presentation to the World Health Organization’s Task Force on the Children’s Environment and Health Action Plan for Europe (CEHAPE), Limassol, Cyprus, October 16-17, 2006.

• WHO, 2002 and 2004 – http://www.who.int• WHO, 2006. Preventing Disease through Healthy Environments.• http://www.who.int/quantifying_ehimpacts/publications/preventingdisease/en/