SCERP Project Number: WQ93-34
Principal Investigator: C. Wesley Leonard
The University of Texas at El Paso/Center for Environmental Resource Management
Rationale: The provision of safe water is one of the most critical health issues along the U.S.-Mexico border. This is especially true in low-income, outlying areas without the resources to develop utility water delivery systems. The comprehensive solution to this problem is complex and will require the investment of billions of dollars, not now available, to provide the infrastructure required for water delivery systems and for water and wastewater treatment plants. In the meantime, however, steps can be taken to ensure that impacted populations have access to appropriate techniques that will make a difference. A successful pilot-scale project could be expanded to include a much broader population base where there are similar water and sanitation conditions.
Approach: The project demonstrated appropriate low-cost/no-cost water purification and wastewater techniques to selected low-income populations on both sides of the U.S.-Mexico border. Workshops for volunteer outreach workers and educational materials in English and Spanish were developed. A bilingual technician conducted the workshops and demonstrations, while the volunteer outreach workers conducted in-home demonstrations, made follow-up visits to participating households, and monitored the chlorine levels of the drinking water. The families also received simple technologies and educational materials regarding water disinfection.
The project staff selected a total of six colonias, three on each side of the border, at high risk of diarrheal disease to implement the pilot project. Site selection was done in conjunction with social service agencies and academic institutions in the United States and Mexico.
Status: All activities for the pilot-scale project have been completed.
The project staff performed a needs assessment prior to program design in order to determine the "approach." The needs assessment, which included technical as well as socio-cultural information concerning the communities, ensured cultural, linguistic and technical relevance. A community-based model with a strong training component was selected in order to reach the full potential of the project.
A model for improving water quality in low-income border communities was developed. The Hygiene Education and Appropriate Technologies Model (HEAT) was field tested in six communities on both sides of the U.S.-Mexico border. The results indicate that the model was successful in achieving acceptance and improving the quality of drinking water as well as the quality of life in these areas.
The program provided intermediate assistance in water quality, hygiene and sanitation to areas that still do not have adequate potable water or sewerage infrastructure.
During the pilot phase of the project, 525 families were reached. The strategy identified and involved a total of 51 volunteers from each of the various communities and provided them with 18 hours of training in hygiene promotion and water purification techniques that enabled them to effectively work with residents. A training manual was developed to meet the volunteers' training needs and a diploma was awarded to those who completed the training and 25 hours of service to their community.
Each volunteer worked with ten families at high risk of diarrheal disease. Over the course of five weeks they were able to: a) train household caretakers how to disinfect their water through demonstrations of proper use of household chlorine or boiling; b) communicate the importance of proper water storage; and c) teach caretakers how to improve hygiene and sanitation practices.
Families were provided with a five-gallon water container especially designed for water storage. Each had instruction labels regarding water purification and general hygiene on two sides of the container. These water containers meet World Health Organization specifications for drinking water vessels and a similar design was tested in Bolivia by the U.S. Center for Disease Control and Prevention. Households were also provided with a protective polyethylene 55 gallon drum liner and an instruction label to be placed outside the drum. These unlined drums are used by colonia residents for water storage and constitute a risk since their previous contents are unknown, and in many cases may have contained hazardous or toxic chemicals.
A medicine dropper for dispensing chlorine and an easy to understand booklet containing the key messages of the project regarding water and hygiene were also provided. Volunteers were provided with a simple chlorine tester to measure household chlorine levels and register improvements during the five week intervention.
Impact was carefully monitored by the volunteers who administered weekly questionnaires, a total of five, to each household. Analysis of specific variables shows a clear and significant impact on both behavior and water quality.
Figure 1.
Figure 2.
Figure 3: DIARRHEA: Similar positive changes also occurred in the incidence of diarrhea. As Figure 3 shows, survey data from the first visit indicated that the reported household prevalence of diarrhea was 22 percent. By the fifth visit, the household incidence of diarrhea was 6 percent.
Figure 4: PARTICIPANT KNOWLEDGE: Changes in the caretaker's understanding of fecal-oral contamination occurs and how enteric disease is transmitted were significant. Figure 4 indicates that on the first visit only 13 percent of the caretakers believed that excrement, through fecal-oral contamination, caused diarrhea. By the fifth visit, however, 46 percent of the caretakers understood the primary cause of diarrhea.
FECAL CONTAMINATION: The incidence of the presence of fecal material in or around the household diminished significantly over the course of the intervention. Survey data showed that on the first visit, the incidence of fecal material observed was 21 percent. By the fifth visit, that figure fell to 10 percent.
OVERALL RESULTS: The preliminary results demonstrate overwhelming acceptance and utilization of both the technical and the educational components of the project. The program has had a significant impact on the quality of drinking water, and most importantly, on the quality of life of families participating in the program. Furthermore, many of the volunteers and participating households expressed their interest in the continuation of project activities in their communities. They offered to set up distribution centers in their homes and to work with the local social or community service agencies to cover the costs. Many community members involved in the pilot program and those who could not be served during this phase indicated their willingness to pay, at or above cost, for the simple technology package offered.
Potential Users/Technology Transfer:
The results of the field-test of the HEAT model indicate that it is successful for improving water quality and can be continued, as well as expanded to other areas having the same problems.
The model has demonstrated the importance and impact that a community based hygiene education and water disinfection project can have. However, the demand for the technologies and water disinfection instruction provided during the first phase was greater than could be provided. In the communities where the program was implemented, several volunteers generated lists of families who wanted to be part of the program but could not be served during this phase.
A subsequent phase of this project should transfer the technical and educational skills developed and implemented during the pilot phase to community agencies in the El Paso-Juarez area, as well as to other border communities sharing the problems which the model was designed to address.
The following agencies were involved in the pilot phase: the El Paso City/County Health and Environmental District, the Mexican Health Department (Secretaria de Salud), the Kellogg Binational Primary Health Care Project (PROBINAPS), the Kellogg Community Partnerships Initiative in Health Care Professions Education, the Community Development Department of the Mexican Social Welfare Agency (DIF - Desarrollo Integral de la Familia).
Appropriate mechanisms can also be developed to make the project sustainable for these agencies. Training workshops can be offered to respond to the technical and training needs of agency personnel. Partnerships of academic institutions, social and health services agencies and grass roots organizations can be the beneficiaries of the training and they can in turn work with the high risk household in their respective communities.
In the El Paso/Juarez area, the community agencies, some of which were involved during the pilot phase, can manage and supervise the continuation of services in the pilot communities via "education and distribution centers" located in the homes of volunteers trained during the initial phase. The technologies can be provided through these centers with the requirement that the beneficiaries receive instruction from the volunteers on water disinfection and diarrheal disease prevention.
The drinking water container and drum liner can be sold at cost or higher to establish a revolving fund in order to ensure project sustainability and expansion.
The end goal is that household water disinfection and hygiene education become part of the regular activities at collaborating agencies. Institutionalization at these and other agencies would be a step toward sustainability, which is the ultimate goal of this model.
Other Personnel:
Beatriz E. Vera, M.A.
Program Coordinator
Chris Bessenecker, M.P.H.
Graduate Research Assistant
James VanDerslice, Ph.D.
University of Texas at Houston Health Science Center
Technical Advisor
Ing. Mauricio Mercado
Universidad Autonoma de Ciudad Juarez
Hydrology Master Program
Technical Consultant
Eva Moya, MSW, CSW
Community Development Director
"Community Partnerships"
A W.K. Kellogg Foundation Initiative in Health Professions Education
El Paso, Tx.
Lic. Patricia Nunez
Community Development Director
Sistema Municipal para el Desarrollo Integral de la Familia - DIF
Ciudad Juarez, Mexico
The FY93 SCERP-supported phase of this project:: WQ93-34
The FY95 SCERP-supported phase of this project: WQ95-4
Last updated 7/1/99