The WATER INSTITUTE · approach to water issues, including strengths in aquatic biology, drinking water chemistry and treatment, wastewater and sludge treatment, groundwater protection,

The

WATER INSTITUTE

at

UNCSix Year Review

THANK YOU

THE WATER INSTITUTE AT UNC | SIX YEAR REVIEW

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We are especially grateful for the generous support of the UNC General Administration Fund, the Office of the Chancellor, The Gillings Gift

to the UNC School of Public Health, Don and Jennifer Holzworth, Stephen Morse, and Michael Cucchiara.

Individual Contributions

Dr. Michael Aitken and Ms. Betsy B. Rudolph

Dr. Marcia Angle and Mr. Mark Trustin

Ms. Nina Baird

Mr. Michael and Mrs. Carol M. Baum

Dr. Andrea Biddle and Mr. Dean Zehnder

Ms. Anne Bisese

Ms. Maryanne Boundy and Mr. Daniel L. Costa

Mr. Andy and Mrs. Rebecca Diamondstein

Dr. Peggye Dilworth-Anderson

Dr. Elizabeth Dunn

Mrs. Francesca and Mr. Jeffrey Eischen

Ms. Marisa Gallegos

Ms. Julia Ganzi

Ms. Jodi Gentry

Mr. William Gentry

Mr. William Gerhard

Dr. Angelique Habis

Ms. Signe Hanson

Ms. Kristen Hassmiller Lich

Ms. Marta Johnson

Mr. E. Andrew Kubiak

Mr. Mauricio Larenas

Dr. Linda and Mr. Maylon Little

Dr. Timothy and Mrs. Pradhana Mastro

Ms. Robin Maycock

Ms. Jessica Minjares-Rauschenber

Dr. Stephen and Mrs. Brenda Morse

Mr. Shankar Narayanan

Mrs. Mary Oglesby

Ms. Michela Osborn

Mr. Robert Patrovic

Mr. Puon Pen

Mrs. Amy and Mr. Joseph W. Pitt

Ms. Jacqueline Quirk

Mr. Perialwar Regunathan

Ms. Lynda Rey

Mrs. Linda and Mr. Brian Sanders

Dr. Kenneth Sexton

Mr. Michael and Dr. Olivia Shelton

Ms. Ann Swies

Mr. Patrick Thompson

Ms. Barbara Wallace

Mr. J. Brent Wishart

Ms. Aimee Woods

Dr. Chen-yu and Mrs. Ray-Whay C. Yen

Dr. Hong Yoo

Mr. Frank and Mrs. Maureen Zarate

Project Sponsors

Adam Smith International

Alaska Native Tribal Health Consortium

Avram Corporation

charity: water

Centers for Disease Control and Prevention (US)

Michael and Susan Dell Foundation

Department for Environment, Food, and Rural Affairs (UK)

Department for International Development (UK)

Department of Foreign Affairs and Trade (Australia)

Engility Corporation

The FEMSA Foundation

Fogarty International Center, National Institutes of Health

The Bill & Melinda Gates Foundation

Georgia Institute of Technology

Health Canada

Conrad N. Hilton Foundation

International Association of Plumbing and Mechanical Officials

IRC (The Netherlands)

International Water Association

International Water Centre (Australia)

London School of Hygiene & Tropical Medicine

Millennium Water Alliance

National Environmental Health Association

National Science Foundation (US)

North Carolina Sea Grant

P&G Children’s Safe Drinking Water Program

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PATH

Plan International USA

Procleanse

Robert Wood Johnson Foundation

TK Holdings, Inc.

Suez S.A.

UN World Water Assessment Programme

UNC Carolina Global Initiative

UNC Gillings Innovation Laboratory

UNEP Risøe Centre

UNICEF

UN University, World Institute for Development and Economic Research

University of Bristol

University of Leeds

Environmental Protection Agency (US)

United States Agency for International Development

Wallace Genetic Foundation

WaterAid UK

Water and Sanitation Rotarian Action Group

Water Environment Research Foundation

Wells Fargo Foundation

World Bank

World Health Organization

World Vision

Conference Sponsors

300in6

American Water Works Association

Amway

Aquagenx

Aquatest (University of Bristol)

Artel

Bawell

Biovision

Bio-Rad Life Science Group

Catholic Relief Services

Charm Sciences, Inc.

Collegiate Capital Management

Conrad N. Hilton Foundation

CSR Wire

Environmental Science and Technology Journal

FHI 360

GRM Futures Group

H2gO Purifier

International Association of Plumbing and Mechanical Officials

P&G Children’s Safe Drinking Water Program

Profile Products

RTI International

Securing Water for Food

Sensus

Solar Solutions

Suez S.A.

The Millennium Institute

TK Holdings, Inc.

Tomlinson Industries

Triangle Global Health Consortium

Triple Quest

UNC Center for Law, Environment, Adaptation and Resources

UNC Global Research Institute

UNC Institute for the Environment

UNC Water in our World Theme

US Water Partnership

Vestergaard Frandsen

Wells Fargo Foundation

World Society for the Protection of Animals (WSPA)

World Wildlife Fund (WWF)

One of the most enduring emblems of the University of North Carolina at Chapel Hill, the Old Well, was the sole source of drinking water for campus for much of the 19th century.

DEAN’S MESSAGE


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We saw “water” in its diverse forms as a critical future challenge to improving and sustaining public health. One urgently needing solutions. We also knew that Gillings and Carolina had the necessary ingredients to put us at the forefront of the response, to let us do what we do particularly well: solve some of the world’s greatest health challenges. We recruited Jamie Bartram from the World Health Organization to serve as the founding Director of The Water Institute at UNC and began a series of initiatives spanning research, conferences, and knowledge management. Earlier this year, the University concluded its formal review of the Institute, concluding that “in six short years the Water Institute has carved out an estimable role as one of the most important centers for applied research

and knowledge synthesis on [water, sanitation and hygiene-related] issues in the entire world.”

One of the most important characteristics of The Water Institute is its clear linking of water to health. It generates evidence, conducts operational research, implements monitoring, evaluation and learning, and promotes awareness and advocacy. These important tools are used in all aspects of the Water Institute’s efforts, and the emphasis on evidence-based interventions is critical. They both create the evidence and synthesize the larger field of water interventions. They work with organizations, communities, companies and governments. They are everywhere, solving problems and saving lives.

The Water Institute has identified and responded to opportunities and — critically — identified where and how they can best spur improvement at the intersections of water, development, and health. Reading this report makes me deeply proud of Jamie Bartram and his team. All over the world, they are confronting some of the toughest questions regarding water and sanitation and providing practical solutions that can be used by people on the ground, in real time. Their focus, tireless pursuit of practical solutions, and drive to leverage all that the University has to offer for sustainable access to safe water and sanitation are exemplary and inspiring. We call ourselves the solutions school. The Water Institute is the personification of our vision. I look forward to many more years of groundbreaking work.

In 2009, the Gillings School of Global Public Health embarked on a major initiative.

Barbara K. Rimer

DIRECTOR’S MESSAGE


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Many of our early decisions have proven sound. Building on the core functions of an academic institution is perhaps the most obvious. Less obvious, but in keeping with the values of the Gillings School of Global Public Health, was a focus on problem solving, which demanded that we review everything we do in terms of relevance to policy, programming, and practice.

Focusing on influencing international development policy as the world pivoted from Millennium Development Goals to the far more ambitious Sustainable Development Goals provided an opportunity to influence large-scale policy, while the decision to selectively partner with implementing organizations enabled us to contribute

directly to better programming: programming with more impact, that is more efficient, and that emphasizes problem solving.

I believe that we have developed a specific niche, combining academic rigor to secure relevant objective insights with real-world engagement in order to focus on the challenges confronting policymakers, practitioners, and those running programs large and small, worldwide. More than anything, this focus defines what The Water Institute stands for: working with others to make the world a better place, rather than describing and lamenting the inadequacies around us!

The last six years have been a whirlwind of activity in setting up and launching The Water Institute at UNC, and 2016 finally provided an opportunity to look back and reflect.

Jamie Bartram

CONTENT

7 Our Backstory

11 The Intersection of Water, Health and Development

12 By the Numbers

16 Monitoring, Evaluation and Learning

20 Adaptation toClimate Extremes

24 International Policy and Monitoring

28 Health Systems and Healthy Environments

32 Drinking Water

36 Sanitation

40 Governance

46 Research

62 Our People

78 Finances

Focus Areas

Functions

50 Networking and Partnership

54 Teaching and Learning

58 Knowledge Managementand Communications

People & Finances

Our

BACKSTORY

Two of the earliest American academic studies concerning water, sanitation, and drinking water quality were authored in the 1870s by a UNC professor: William Cain, a member of North Carolina’s first Board of Health.

In the early twentieth century, Professor Herman G. Baity was a pioneer, developing systems and influencing policies that brought clean water to people across the US and the world. His leadership as Dean of Engineering at UNC helped keep the Sanitary Engineering program in Chapel Hill, even after other engineering programs were moved to what is now North Carolina State University. Baity left UNC to become the first head of environmental health at the World Health Organization (WHO) a role later filled by our current director.

From the mid-1950s, initially under the leadership of Daniel Okun, UNC became known worldwide for its work in water supply and management, pollution control, water reclamation and reuse, and watershed protection. UNC is renowned for its comprehensive approach to water issues, including strengths in aquatic biology, drinking water chemistry and treatment, wastewater and sludge treatment, groundwater protection, and water resource policy, with applications at the local, state, national, and international levels.

he University of North Carolina has the oldest connection to water issues of any public university in the United States.T


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The Water Institute at UNC was launched in October 2010 at the first Water and Health Conference. The conference has since emerged as one of the most important gatherings worldwide for both established leaders and enterprising newcomers in water, health, and development. This signature event provides a platform to share research findings that can inform future policy.

Since its founding, The Water Institute has tackled ongoing and emerging issues of central importance to global public health with a commitment to improve policy, programming, and practice. Institute researchers have published numerous scientific papers and reached large audiences with knowledge products that translate insights into practical action. The Institute’s recommendations on global WaSH goals, targets, and indicators have supported policymaking and helped shape agendas around water supply and quality, sanitation and sewerage, environmental health in health care and school settings, and human rights. The implications of our work have been reflected in the incorporation of the word ‘safe’ in the Sustainable Development Goals’ water and sanitation targets, and the aspiration to ensure that every household has adequate water and sanitation.

Reflecting the core values of the university and carrying forward the Gillings School of Global Public Health’s history of innovation in the service of public health, The Water Institute has focused on effecting change. Its research, teaching, networking, and knowledge management activities focus on leveraging evidence to upgrade policies, to enhance program design, and management, and to improve practice, all toward the goal of improving health and development in North Carolina and around the world.


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Water is the defining challenge of the 21st century, intersecting with a range of development issues that grow more urgent with each passing year: health, agriculture, economics, politics, security, gender, ecology, and many more. Recognizing that progress toward equal access to safe, healthy water will foretell the future development, safety, and prosperity of every country, UNC recruited Jamie Bartram, then head of Water, Sanitation, Hygiene, and Health at the World Health Organization, to lead a new multidisciplinary effort.

Since its founding, The Water Institute has tackled

ongoing and emerging issues of central importance to global

public health with a commitment to improve policy, programming,

and practice.


We follow the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Inadequate water, sanitation, and hygiene has been a major cause of disease throughout recorded history. Rapid progress in water over recent decades shows that implementing good practice founded on rigorous evidence offers substantial opportunities to improve the well-being of communities the world over.

We intend development to refer to both human development, the process of enlarging people’s freedoms and opportunities and improving their well-being, and also to sustainable development, development that meets the needs of the present without compromising the ability of future generations to meet their own needs.

WATER, HEALTH AND DEVELOPMENT

The Intersection of

For us, water refers to water resources, water supply, sanitation and hygiene – it incorporates a complex and inter-related range of natural resources, infrastructures, services and behaviors. Improvements in access to drinking water and sanitation have been rapid in recent decades, prompting the adoption of global Sustainable Development Goals with ambitious targets. Against this background of remarkable progress, increasing populations are water scarce, and climate-related increases in frequency of extreme weather events– especially floods and droughts – imperil the infrastructures and services that underpin achievements to date.

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HEA

LTH

WA

TER

DEVELOPMENT

While we work principally at the nexus of water, health and development, these issues are themselves managed, whether locally or nationally, by intersecting sectors which they constrain and facilitate and that make conflicting demands. We also tackle water in this wider context: the nexus of water, energy and food.


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BY THE NUMBERSProblems – and progress – in water, development, and health

yield statistics that tell a compelling story.

Up to

70%of the burden for

collecting drinking water is on

women and girls

No major cityin fast-urbanizing India provides its residents with continuous piped

water supply

In some cities

50%of energy is used for pumping and treating water and wastewater

Deaths due to unsafe water, sanitation,

and hygiene

dropped40%

from 1990 to 2015

19%of health care

facilities do nothave a toilet

of sewage worldwide is untreated, mainly

in upper-middle income countries

67%

More than

50%of the developing

world’s primary schoolslack water and

sanitation facilities

Between 1990 and 2015

2 billionmore people

had household access to drinking water

40%of diarrheal deaths

could be prevented by sanitation and hand-

washing

70%of the water taken by humans from rivers, lakes, and

groundwater goes to agriculture

60%of countries have

water, sanitation, and hygiene policies that include measures for

people living with disabilities

In Iceland clinical

diarrhea was reduced

14%due to

Water Safety Plans

1%of spending on drinking water and sanitation in developing countries

comes from aid and that is mostly loans

Almost halfof the world’s workers – 1.5 billion people – work in water-related sectors

38%of health care

facilities lack a safe water source

nearly6 timesmore

In Nairobi, informal settlement residents who get water from

kiosks pay

than the cost of piped water

he mission of The Water Institute at UNC is to provide global academic leadership for economically, environmentally, socially,

and technically sustainable management of water, sanitation, and hygiene for equitable health and human development. We aim to be a vibrant, interdisciplinary center that unites faculty, students, and partners from North Carolina and from high- and low-income nations worldwide.


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T

Our goal is to drive effective policy, programming, and practice in water, sanitation, and hygiene that protect and improve human health and wellbeing worldwide and that predict and prevent emerging risks.

The Water Institute’s activities are centered on focus areas, selected to represent important but under-addressed challenges, and justified by problem definition, opportunity characterization, and impact potential. We respond to each with activities from our four functions: research, networking, teaching, and knowledge management. While our focus areas are flexible and evolve in response to emerging needs, functions provide a stable framework for action.

Teaching and LearningNetworking and

Partnership Knowledge ManagementResearch

Global Academic Leadership

Governance and Regulation

Drinking Water

Monitoring, Evaluation, and

Learning

International Policy and Monitoring

Health Systems and Healthy

Environments

Adaptation to Climate

Extremes

Sanitation


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Monitoring, Evaluation, and Learning

Working with implementing organizations to apply efficient monitoring and evaluation to increase and sustain impacts and benefits.

Adaptation to Climate Extremes

Increasing the resilience and reducing the vulnerability of drinking water and sanitation systems to climate extremes.

International Policy and Monitoring

Generating evidence and providing recommendations to implement and improve international development policies and monitoring on water, sanitation, and hygiene.

Health Systems and Healthy Environments

Minimizing disease burden, improving health service delivery, and protecting the environment by influencing the interactions between health systems and human and environmental health.

Drinking Water

Improving water systems to deliver better levels of service and improvements to health, wellbeing, and economy.

Sanitation

Identifying effective approaches to tackle the sanitation crisis, especially for the urban poor, where the services backlog and the worst of conditions collide.

Governance and Regulation

Advancing evidence-based policies and enhancing local and national governance and management to ensure high quality water and sanitation services for all.

Water, sanitation, and hygiene programs often monitor expenditures and outputs, but many lack evidence adequate to increase efficiency and impact. Without robust data on functionality, quality, sustainability and service delivery, programs are hindered in their ability to take preventative and corrective action.

Through robust metrics and data collection tools, major opportunities exist to use monitoring and evaluation to improve the benefits of water, sanitation and hygiene programs, especially for those who need it most. When monitoring is fit for purpose, the resulting evidence can be used by everyone to improve service delivery.

Our goal is to build and strengthen monitoring, evaluation and learning (MEL) that enables and empowers people to collect data, analyze it, and act. We build best-in-class MEL frameworks and systems for our partners to track provision and sustainability at all service levels. Our innovative and accessible tools and toolkits can be adapted and scaled to meet the monitoring needs of any program or organization. We share and foster best practices to enable our partners to efficiently improve their programs and projects, achieve service level targets, and expand their beneficial impacts.

MONITORING, EVALUATION AND LEARNING

Working with implementing organizations to apply efficient monitoring and evaluation to

increase and sustain benefits.


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Impact: Continuous Quality Improvement in Water, Sanitation, and Hygiene

The Water Institute introduced Continuous Quality Improvement (CQI) as an action-driven solution for complex challenges in water, sanitation, and hygiene. CQI identifies areas for improvement and requires that improvements be monitored over time. Through locally implemented CQI projects in Ghana, Mali, Niger and Burkina Faso, we have improved safe management of household drinking water and built the capacity of community-level water committees to maintain functionality of water sources. We saw improvements that are rarely seen in development: the proportion of households with water considered high risk according to the WHO classification was halved.

Over the next 5 years, we will work with some of the world’s largest water and development organizations to expand MEL and CQI to between five and ten additional countries. This work could double our partners’ measurable contribution to the UN’s Sustainable Development Targets 6.1 and 6.2 between 2016 and 2020.

Insight: Understanding handpump sustainability: determinants of rural water source functionality in the Greater Afram Plains of Ghana

In rural sub-Saharan Africa, a large proportion of “improved” water sources are boreholes with handpumps. One-third are nonfunctional at any given time. The Water Institute analyzed data from 1509 water sources in 570 communities in the rural Greater Afram Plains region of Ghana — one of the largest studies of its kind. We found that functionality depended on the age of the borehole, maintenance and administration practices, tariff collection, the number of other water sources in the community, pump type, and the availability of tools. Using statistical methods that have not been applied to this problem before, we identified strong synergy between management and other determinants of functionality, suggesting that improvements in management has disproportional benefits.

The Water Institute worked with the Conrad N. Hilton Foundation to create and validate a MEL framework that would enable the Foundation to better understand its partners’ water, sanitation, and hygiene programs. The framework comprises robust indicators, metrics and tools for collecting data on program progress and partner performance. Between 2013 and 2016, we expanded this work to Foundation implementing partners in five countries and it is now being adopted by other donor and implementing organizations.

PROJECTS


Monitoring, Evaluation, and Learning for WaSH (Conrad N. Hilton Foundation)

Baseline Assessment for MWA: Latin America Program (Millennium Water Alliance)

Baseline Assessment in Ethiopia (UNICEF)

Developing a unified monitoring and evaluation system for charity: water and its partners (charity: water)

Past Evaluation Review and Mid Term Evaluation Design for World Vision WaSH Program (World Vision)

Aquatest: Scenarios of Testing and Regulatory Framework (Bristol University)

Midline survey for the integrated Water, Sanitation, and Hygiene Multiple-Use Water Services Community-Based Nutrition program in Amhara Oromia Southern Nations, Nationalities, and Peoples’ and Tigray regions in Ethiopia (UNICEF)

Evaluation of Technology Related to Sustainable Management of WaSH and Human Development (TK Holdings)

Improving the Regulation, Monitoring and Quality of the Packaged Water Industry in Sierra Leone (Adam Smith International and Department for International Development UK)

Institutional Arrangements for Sanitation: What Can and Should the Health Sector Do? (WaterAid UK)

Monitoring, Evaluation and Learning for WASH (World Vision)

Monitoring, Evaluation and Learning Framework for Millennium Water Alliance-Lazos de Agua Program (Millennium Water Alliance)

Partnership for Sustained Water and Sanitation (Water and Sanitation Rotarian Action Group)

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Monitoring and evaluation can be used to track and improve water, sanitation, and hygiene programs. Mobile survey tools can enhance program quality and efficiency, but with dozens available, users struggle to compare and select suitable options. The Water Institute developed a systematic evaluation framework, based on international standards for software quality, and used it to compare seven mobile survey tools for monitoring. This framework helps users identify tools suitable for their specific needs.

PUBLICATIONS


Evaluating Mobile Survey Tools (MSTs) for field-level monitoring and data collection: development of a novel evaluation framework, and

application to MSTs for rural water and sanitation monitoring.

Swimming Upstream: Why Sanitation, Hygiene and Water Are So Important to Mothers and Their Daughters. Clarissa Brocklehurst and Jamie Bartram. 2010. Bulletin of the World Health Organization 88 (7): 482–482.

Accounting for Water Quality in Monitoring Access to Safe Drinking-water as Part of the Millennium Development Goals: Lessons from Five Countries. Rob E. S. Bain, Stephen W. Gundry, Jim A. Wright, Hong Yang, Steve Pedley, and Jamie Bartram. 2012. Bulletin of the World Health Organization: 228–235A.

Getting Wet, Clean, and Healthy: Why Households Matter. Jamie Bartram, Mark Elliott, and Patty Chuang. 2012. The Lancet 380 (9837): 85–86.

Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress. Kyle Onda, Joe Lobuglio, and Jamie Bartram. 2012. International Journal of Environmental Research and Public Health 9 (3): 880–894.

Domestic Water Service Delivery Indicators and Frameworks for Monitoring, Evaluation, Policy and Planning: A Review. Georgia L. Kayser, Patrick Moriarty, Catarina Fonseca, and Jamie Bartram. 2013. International Journal of Environmental Research and Public Health 2013 (10): 4812–4835.

Assessing the Impact of Drinking Water and Sanitation on Diarrhoeal Disease in Low- and Middle-income Settings: Systematic Review and Meta-regression. Jennyfer Wolf, Annette Prüss-Ustün, Oliver Cumming, Jamie Bartram, Sophie Bonjour, Sandy Cairncross, Thomas Clasen, et al. 2014. Tropical Medicine and International Health 19 (8): 928–942.

Assessing the Microbial Quality of Improved Drinking Water Sources: Results from the Dominican Republic. Rachel Baum, Georgia Kayser, Christine Stauber, and Mark Sobsey. 2014. American Journal of Tropical Medicine and Hygiene 90 (1): 121–123.

Comparison and Cost Analysis of Drinking Water Quality Monitoring Requirements Versus Practice in Seven Developing Countries. Jonny Crocker, and Jamie Bartram. 2014. International Journal of Environmental Research and Public Health 11 (7): 7333–7436.

Country Clustering Applied to the Water and Sanitation Sector: A New Tool with Potential Applications in Research and Policy. Kyle Onda, Jonny Crocker, Georgia Lyn Kayser, and Jamie Bartram. 2014. International Journal of Hygiene and Environmental Health 217: 379–385.

Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges. Jamie Bartram, Clarissa Brocklehurst, Michael B Fisher, Rolf Luyendijk, Rifat Hossain, Tessa Wardlaw, and Bruce Gordon. 2014. International Journal of Environmental Research and Public Health 11(8): 8137–8165.

Association of Supply Type with Fecal Contamination of Source Water and Household Stored Drinking Water in Developing Countries: A Bivariate Meta-analysis. Katherine F. Shields, Robert E. Bain, Ryan Cronk, Jim A. Wright, and Jamie Bartram. 2015. Environmental Health Perspectives 123 (12), 1222-1231.

Microbiological and chemical quality of packaged sachet water and household stored drinking water in Freetown, Sierra Leone. Michael B. Fisher, Ashley R. Williams, Mohamed F. Jalloh, George Saquee, Robert E. S. Bain, and Jamie K. Bartram. 2015. PLoS ONE 10.7: e0131772.

Monitoring Drinking Water, Sanitation, and Hygiene in Non-Household Settings: Priorities for Policy and Practice. Ryan Cronk, Tom Slaymaker, and Jamie Bartram. 2015. International Journal of Hygiene and Environmental Health. 218.8: 694-703.

Sustainability and scale-up of household water treatment and safe storage practices: enablers and barriers to effective implementation. Edema Ojomo, Mark Elliott, Lorelei Goodyear, Michael Forson, and Jamie Bartram. 2015. International Journal of Hygiene and Environmental Health. 218.8: 704-713.

Understanding handpump sustainability: Determinants of rural water source functionality in the Greater Afram Plains region of Ghana. Michael B. Fisher, Katherine F. Shields, Terence U. Chan, Elizabeth Christenson, Ryan D. Cronk, Hannah Leker, Destina Samani, Patrick Apoya, Alexandra Lutz, and Jamie Bartram. 2015. Water Resouces Research. 51.10: 8431-8449.

Michael B. Fisher, Ben H. Mann, Ryan D. Cronk, Katherine F. Shields, Tori L. Klug, Rohit Ramaswamy. 2016. International Journal of Environmental Research and Public Health, 13(9), 840.

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To view a complete listing of our publications, please visit https://waterinstitute.unc.edu/research/publications/

Extreme weather events affect all regions of the world, with projected increases in the intensity and frequency of droughts, floods, and cyclones threatening the ability of governments and utilities to protect infrastructure and sustain essential water and sanitation services.

Extreme weather events and water scarcity threaten the integrity and functionality of aging water and sanitation infrastructure in high income countries and hinder expansion of services in low income settings. As countries replace aging infrastructure and expand and upgrade water and sanitation services, they need to identify, adopt, and implement effective strategies to increase the resilience of water and sanitation services.

The Water Institute’s work on adaptation to climate extremes assesses the vulnerability of drinking water and sanitation systems at different scales, identifies, and ranks opportunities for adaptation, and distinguishes, curates and disseminates promising practices. We believe that understanding the vulnerability of water and sanitation services and anticipating future challenges can inform adaptation strategies that will help to increase resilience to climate extremes.

ADAPTATION TOCLIMATE EXTREMES

Increasing the resilience and reducing the vulnerability of drinking water and sanitation

systems to climate extremes.


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Insight: Mapping the Vulnerability of Drinking Water Systems to Storm Surges and Heavy Rainfall in Coastal Vietnam and the Philippines

Approximately 40% of the global population lives along coastlines, making coastal areas very vulnerable to climate change. Vulnerability analyses can help forestall the worst effects, but conventionally, they focus on individual types of hazardous events. We mapped the vulnerability of drinking water systems in coastal Vietnam and the Philippines to the co-occurrence of heavy rainfall and storm surge which decision-makers can use in developing policies and implementing programs that increase the resilience and reduce the vulnerability of these coastal regions. Our results suggest that specific local adaptation programs may be more effective than a “one-size-fits-all” approach.

Impact: Adaptation to Climate Extremes: Assessing Global Practice

Little is known about what actions utilities are taking across the globe to adapt to climate extremes. The Water Institute has compiled a database of actions that will be made available online. We are currently working with the US EPA to include US cases from our database in their newly launched map of climate change adaptation among US water utilities, which will increase the scope and potential impact of both our own work and the EPA’s initiative.

The Pacific Island Countries failed to meet the UN Millennium Development Goal target for drinking water and sanitation, with the smallest increases in access of any region. Water and sanitation programming in the region is a particular challenge because of disproportionate vulnerability to storms, floods, and droughts. To explore the impacts of these unpredictable extreme events, shifting wet and dry seasons, and the benefits of adaptations such as use of multiple sources on water and sanitation access, we used Bayesian Belief Network modeling, which can support decision-making in situations of high uncertainty, with household survey data and key stakeholder interviews.

PROJECTS


Making Disasters Fuel Development: Combining Traditional and Contemporary Knowledge Delivers Effective Technologies, Approaches and Strategies for Climate Resilient WaSH in Pacific Island Countries

(Australian Department of Foreign Affairs and Trade)

Climate Change Impacts on Drinking Water and Sanitation Coverage (Wallace Genetic Foundation)

Diagnosing the Vulnerability of Drinking Water Infrastructure to Synergistic Climate-related Hazards in Coastal Cities (Engility Corporation/USAID)

Impact of Climate Change on United States Drinking Water Vulnerability and Preparedness (Wells Fargo Foundation)

Navigating from Impacts to Adaptation: Climate Change and Water Supply and Sanitation on Atolls and Flood-prone Catchments in the Pacific (International Water Centre-Australian Department of Foreign Affairs and Trade)

Impacts of Climate-related Hazardous Events on Drinking Water and Sanitation Coverage (Wallace Genetic Foundation)

State-by-state US Ranking of Drinking Water and Sanitation Systems for Climate Change Vulnerability and Preparedness (Wells Fargo Foundation)

United Nations Environment Programme/Global Environment Facility Technology Needs Assessment Adaptation Technologies and Options (UNEP Risoe Centre)

Water and Sanitation Service Sustainability: WaSH and Climate Change Country Assessment and Reducing Financial Barriers to Accessing WaSH Services (UNICEF)

Greater Beirut Water Supply Project (World Bank)

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The Water Institute developed this guidebook to provide information on real-world adaptation by the water sector to climate extremes for governmental agencies, water utilities, community water boards, non-governmental organizations, and the private sector. The guidebook assesses the projected impacts of climate extremes on the water sector, provides insights about the role of adaptation in promoting increased water and sanitation security, and describes eleven specific adaptation technologies and practices.

PUBLICATIONS


Technologies for Climate Change Adaptation – The Water Sector.

Vision 2030: The Resilience of Water Supply and Sanitation in the face of Climate Change, Summary and policy implications. Guy Howard and Jamie Bartram. 2009. World Health Organization, Geneva.

Securing 2020 Vision for 2030: Climate Change and Ensuring Resilience in Water and Sanitation Services. Guy Howard, Katrina Charles, Kathy Pond, Anca Brookshaw, Rifat Hossain, and Jamie Bartram. 2010. Journal of Water and Climate Change 1 (1): 2–1.

Building Integrated Approaches into the Sustainable Development Goals: A Declaration from the Nexus 2014: Water, Food, Climate and Energy Conference in the name of the Co-directors held at the University of North Carolina at Chapel Hill, March 5th to 8th 2014. Felix Dodds and Jamie Bartram. 2014. Chapel Hill: The University of North Carolina at Chapel Hill.

Climate-Related Hazards: A Method for Global Assessment of Urban and Rural Population Exposure to Cyclones, Droughts, and Floods. Elizabeth Christenson, Mark Elliott, Ovik Banerjee, Laura Hamrick, and Jamie Bartram. 2014. International Journal of Environmental Research and Public Health. 11 (2), 2169–2192.

The Plain Language Guide to Rio+20: Preparing for the New Development Agenda. Felix Dodds, Jorge Laguna-Celis, and Liz Thompson, eds. 2014. New World Frontiers Publishing.

Climate Change Preparedness: A Knowledge Attitudes and Practices Study in Southern Nigeria. Edema Ojomo, Mark Elliott, Urooj Amjad, and Jamie Bartram. 2015. Environments. 2, 435-448.

Putting WASH in the Water Cycle: Climate Change, Water Resources and the Future of Water, Sanitation and Hygiene Challenges in Pacific Island Countries. Wade L. Hadwen, Bronwyn Powell, Morgan C MacDonald, Mark Elliott, Terence Chan, Wolfgang Gernjak, and William G L Aalbersberg. 2015. Journal of Water, Sanitation and Hygiene for Development. 5 (2), 183-191.

Vulnerability Assessment for Loss of Access to Drinking Water Due to Extreme Weather Events. Jeanne Luh, Elizabeth C. Christenson, Aizhan Toregozhina, David A. Holcomb, Tucker Witsil, Laura R. Hamrick, Edema Ojomo, and Jamie Bartram. 2015. Climatic Change. 133 (4), 665-679.

Adapting Drinking-water Systems to Coastal Climate Change: Evidence from Viet Nam and the Philippines. Edema Ojomo and Jamie Bartram. 2016. Regional Environmental Change. 16 (8), 2409-2418.

Climate Change and Water and Sanitation: Likely Impacts and Emerging Trends for Action. Guy Howard, Roger Calow, Alan Macdonald, and Jamie Bartram. 2016. Annual Review of Environment and Resources. 41: 253-276.

Planning for Climate Change: The Need for Mechanistic Systems-Based Approaches to Study Climate Change Impacts on Diarrheal Diseases. Jonathan E. Mellor, Karen Levy, Julie Zimmerman, Mark Elliott, Jamie Bartram, Elizabeth Carlton, Thomas Clasen, Rebecca Dillingham, Joseph Eisenberg, Richard Guerrant, Daniele Lantagne, James Mihelcic, Kara Nelson. 2016. Science of the Total Environment. 548-549, 82-90.

The history of the Nexus at the intergovernmental level. Felix Dodds and Jamie Bartram. 2016. In The Water, Food, Energy and Climate Nexus: Challenges and an Agenda for Action, edited by Felix Dodds and Jamie Bartram, 7-46. New York, NY: Routledge.

Mark Elliot, Andrew Armstrong, Joseph Lobuglio, and Jamie Bartram. 2011. TNA Guidebook Series. Roskilde, Denmark: UNEP Risoe Centre.

23


The Water Institute’s first six years coincided with major international policy developments: in 2010, the UN recognized the human right to water and sanitation, and in 2015 the Millennium Development Goals were judged a qualified success and superseded by more ambitious Sustainable Development Goals (SDGs), with eight associated water- and sanitation-related targets for 2030.

Achieving universal access to safe and reliable water and sanitation will depend on monitoring that identifies barriers and opportunities, informed policy development, and implementation efforts that ultimately lead to extending and improving services. Effective monitoring requires an international framework that tackles and reconciles diverse challenges such as inequalities and cost-effectiveness. Insight into factors that hinder or promote the impact of policies must include the enabling environment: institutions, policies, and regulations, and the influences of social, cultural, political, economic and environmental circumstances on policy, programming, and practice.

The Water Institute generated evidence to inform the transition from the MDG to the SDG period. Our research influenced the monitoring of drinking water safety, which was not included in the MDGs, and we advocated for universal coverage targets including both household and non-household settings. We now work on providing insight into effective international monitoring and policy, where we seek to understand how institutions, stakeholders, and policies can cooperate to provide safe water and sanitation services.

INTERNATIONAL POLICY AND MONITORING

Generating evidence and providing recommendations to implement and improve effective international development

policies and monitoring on water, sanitation, and hygiene.


25

Insight: Does Global Progress on Sanitation Really Lag Behind Water? An Analysis of Global Progress on Community- and Household-Level Access to Safe Water and Sanitation

Strikingly different criteria are used in international monitoring of water and sanitation. During 1990-2015, access was measured at the community-level for water, but at the household-level for sanitation, so a pit latrine shared between even two households did not count toward sanitation access, but a single well serving an entire dispersed village counted for every household. We re-calculated global progress for water and sanitation using equivalent household- and community-level benchmarks. We show that the much-cited “sanitation deficit” disappears when equivalent benchmarks are used, and that sanitation progress during 1990-2015 was actually faster than that of water. This study highlighted the fundamental importance of defining benchmarks during target formulation and evaluation of trends and progress. We recommended that household-level access be used for both water and sanitation: the benchmark that was adopted for the Sustainable Development Goals.

Impact: Accounting for Water Quality in Monitoring Access to Drinking water and the Resulting Impact on MDG Progress

To inform discussions about SDG targets, we assessed how understanding of the status of and progress in access to drinking water during the MDG period was modified by accounting for water quality and sanitary risk. The MDG indicator for access to safe drinking water considered whether a water source type was ‘improved.’ Using water quality data from five countries, we modeled microbial water quality and sanitary risk for countries without available data. We showed that the proportion of the population using an unsafe source was far higher than the “improved source” indicator suggests, changing from 12% to 28% in 2010. Accounting for sanitary status further increases this to 47%. This work contributed to the inclusion of the term “safely managed” in the SDG indicator for drinking water.

Household-level benchmark: MDG sub-targets would be met for water in 2032 and sanitation in 2025.

Community-level benchmark: while sanitation coverage is still behind water, its progress is faster than water, and

sanitation MDG target would be met by 2013.

Proportion of world population without access to safe drinking water (1990-2015), adjusted for water quality and sanitary risk.

The human right to water and sanitation requires that countries progressively realize universal access. Existing indicators measure inequality gaps or rates of change in these gaps, neither of which allow fair comparison of progress made by countries at different initial levels of inequalities. We developed an index that ranks countries, normalizing their rate of change against a benchmark. Using this index, we demonstrate that progressive realization can be achieved, regardless of economic status, development progress, or related factors.

PROJECTS


Equity in Water and Sanitation: Developing an Index to Measure Progressive Realization of the Human Right.

Foreign Aid Research and Communication Programme United Nations University-World Institute for Development Economics Research

Getting to Zero – Defining Universal Access to Safe Drinking Water and Sanitation and Understanding Trajectories of Progress (WaterAid UK)

GLAAS+: Revising the Current Global Analysis and Assessment of Sanitation and Drinking-water (GLAAS) Questionnaire and Methodology (WHO)

How Safe Are Improved Sources? Water Quality in Low and Middle Income Countries: Review for Joint Monitoring Programme Post-2015 Water Working Group (WaterAid UK)

In-depth Analysis and Assessment of Global Sanitation and Drinking-water (GLAAS) 2013/14 data (WHO)

Journal manuscripts and report on global water quality by type of source and by region (WHO)

Meeting of Senior Finance Ministry Officials to Discuss Decision-making for WaSH (Bill & Melinda Gates Foundation)

Monitoring Access to Drinking Water Beyond the Household: Review for JMP Post-2015 Water Working Group (WaterAid UK)

Post-2015 Global Monitoring of Urban Water and Sanitation (UNICEF)

Update of “Domestic Water Quantity Service Level and Health” (WHO)

Water Wisdom: Developing Local-Global Capacities in Managing Water (National Institutes of Health/Fogarty International Center)

WHO Sanitation and Health Guidelines (WHO)

26

Countries are commonly grouped by geography and income for comparison (e.g. “Latin America” or “Low-income”). We created a new grouping of countries for water and sanitation based on similarities across nine indicators. The resulting five clusters were statistically superior to the country clusters used in international development (such as the World Health Organization’s regions or World Bank economic groupings). This new typology can be used to improve reporting, inform policy, track progress, identify critical knowledge gaps, and plan research to account for country similarities and differences.

PUBLICATIONS


Country Clustering Applied to the Water and Sanitation Sector: A New Tool with Potential Applications in Research and Policy.

Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress. Kyle Onda, Joe Lobuglio, and Jamie Bartram. 2012. International Journal of Environmental Research and Public Health. 9 (3): 880–894.

Water Safety and Inequality in Access to Drinking-water Between Rich and Poor Households. Hong Yang, Robert Bain, Jamie Bartram, Stephen Gundry, Steve Pedley, and James Wright. 2012. Environmental Science and Technology 47 (3): 1222–1230.

Equity in Water and Sanitation: Developing an Index to Measure Progressive Realization of the Human Right. Jeanne Luh, Rachel Baum, and Jamie Bartram. 2013. International Journal of Hygiene and Environmental Health. 216: 662–671.

Implementing an Evolving Human Right Through Water and Sanitation Policy. Benjamin M. Meier, Georgia L. Kayser, Urooj Q. Amjad, and Jamie Bartram. 2013. Water Policy. 15 (1): 116–133.

Universal Access to Drinking Water: The Role of Aid. Robert Bain, Rolf Luyendijk, and Jamie Bartram. 2013. WIDER Working Paper No. 2013/88. Helsinki: UNU World Institute for Development Economics Research.

Burden of Disease from Inadequate Water, Sanitation and Hygiene in Low- and Middle-income Settings: A Retrospective Analysis of Data from 145 Countries. Annette Prüss-Ustün, Jamie Bartram, Sandy Cairncross, Paul R. Hunter, Richard B. Johnston, Colin Mathers, Daniel Mäusezahl, et al. 2014. Tropical Medicine & International Health. 19 (8): 894–905.

Does Global Progress on Sanitation Really Lag Behind Water? An Analysis of Global Progress on Community- and Household-Level Access to Safe Water and Sanitation. Oliver Cumming, Mark Elliott, Alycia Overbo, and Jamie Bartram. 2014. PLoS ONE 9 (12): e114699.

Examining the Practice of Developing Human Rights Indicators to Facilitate Accountability for the Human Right to Water and Sanitation. Benjamin M. Meier, Jocelyn G. Kestenbaum, Georgia L. Kayser, Urooj Q. Amjad, and Jamie Bartram. 2014. Journal of Human Rights Practice. 6 (1): 159–181.

Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Robert Bain, Ryan Cronk, Jim Wright, Hong Yang, Tom Slaymaker, and Jamie Bartram. 2014. PLOS Medicine. 11 (5): e1001644.

Human Health and the Water Environment: Using the DPSEEA Framework to Identify the Driving Forces of Disease. Jennifer Gentry-Shields and Jamie Bartram. 2014. Science of the Total Environment. 468-469: 306-314.

Improved but Not Necessarily Safe: Water Access and the Millennium Development Goals. Robert Bain, Jim Wright, Hong Yang, Stephen Gundry, Steve Pedley, and Jamie Bartram. 2014. In Global Water: Issues and Insights, 89–94. Canberra, Australia: Australian National University Press.

Rights-Based Indicators Regarding Non-Discrimination and Equity in Access to Water and Sanitation. Urooj Q. Amjad, Georgia Kayser, and Benjamin M. Meier. 2014. Journal of Water, Sanitation and Hygiene for Development 4: 182–87.

Rural: Urban Inequalities in Post 2015 Targets and Indicators for Drinking-water. Robert E. S. Bain, Jim A. Wright, Elizabeth Christenson, and Jamie Bartram. 2014. Science of The Total Environment 490 (15): 509–513.

Monitoring Drinking Water, Sanitation, and Hygiene in Non-Household Settings: Priorities for Policy and Practice. Ryan Cronk, Tom Slaymaker, and Jamie Bartram. 2015. International Journal of Hygiene and Environmental Health. 218 (8): 694-703.

Assessing Progress Towards Public Health, Human Rights, and International Development Goals Using Frontier Analysis. Jeanne Luh, Ryan Cronk, and Jamie Bartram. 2016. PLoS ONE. 11 (1): e0147663.

Drinking Water and Sanitation: Progress in 73 Countries in Relation to Socioeconomic Indicators. Jeanne Luh and Jamie Bartram. 2016. Bulletin of the World Health Organization. 94, 111-121A.

Indicators for Monitoring Water, Sanitation, and Hygiene: A Systematic Review of Indicator Selection Methods. Stephanie Schwemlein, Ryan Cronk, and Jamie Bartram. 2016. International Journal of Environmental Research and Public Health. 13 (3): 333.

Tracking Progress Towards Global Drinking Water and Sanitation Targets: A Within and Among Country Analysis. James A. Fuller, Jason Goldstick, Jamie Bartram, and Joseph N. S. Eisenberg. 2016. Science of the Total Environment. 541: 857-864.

Kyle Onda, Jonny Crocker, Georgia Lyn Kayser, and Jamie Bartram. 2014. International Journal of Hygiene and Environmental Health. 217 (2-3): 379–385.

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Health systems are complex, overemphasize health care delivery, and underplay environmental health despite its impact on the quality and safety of health care. Environmental health includes water, sanitation and hygiene infrastructure, medical and hazardous waste management, drainage, vector control and proper cleaning. Deficiencies increase health care costs and nosocomial infections, decrease quality of care and create ‘downstream’ risks such as community exposure to infectious and toxic hazards and contribute to the proliferation of antibiotic resistance.

Health system actors have an opportunity to improve health outcomes and reduce the cost of care by advocating for increased investment in population health and implementing or emphasizing environmental health.

The Water Institute seeks to mobilize health care providers, clinic supervisors, clinic managers and other health systems actors to integrate evidence-based environmental health considerations with infection control practices. This will reduce health inequalities and improve the safety and quality of health care.

HEALTH SYSTEMS AND HEALTHY ENVIRONMENTS

Minimizing disease burden, improving health service delivery, and protecting the environment by influencing

the complex interactions between health systems and human and environmental health.

GENERATINGEVIDENCE

CONDUCTINGOPERATIONAL

RESEARCH

PROMOTINGAWARENESS& ADVOCACY

IMPLEMENTING,MONITORING,EVALUATION &

LEARNING

Evaluating the impact of interventions in health care facilities

Conducting literature reviews to understand burden of disease, and nosocomial outbreaks in health care facilities

Translating evidence into peer-review journals and web portals to disseminate findings

Translating health care facility based operational research for advocacy at regional and national levels

Partnering with implementing organizations to understand effects and increase impacts of interventions in Cambodia and Mali

Collaborating with others to strengthen monitoring in health care facilities

Conducing health care facility assessments in Malawi and Fiji


29

Insight: More Health for Your Buck: Health Sector Functions to Secure Environmental Health

Despite the inextricable link between health care and environmental health, and the burden of environmentally-mediated disease, the two tend to operate independently. In this paper, we challenge the status quo and promote systems thinking to maximize health benefits. We propose a system that comprises six functions (see figure), and argue for the value of each element and how they interact to reduce the burden of disease in both developed and developing countries. We contend that the health sector has a responsibility to approach primary care in a holistic manner in its organization and delivery of services.

Impact: Water, Sanitation and Hygiene in Health Care Facilities: Status in Low- and Middle-Income Countries and Way Forward

The Water Institute documented, for the first time, that 40% (of 66,000) health care facilities do not have safe water, a third are without soap for hand-washing, and 20% lack a toilet. Few governments have national policies and plans in place to tackle these deficits; we call for urgent action on global, national, and facility levels. We recommend establishing and tracking policies and standards for delivery of services; providing technical and financial support to service delivery; and establishing leadership and coordination to direct health and development efforts toward universal health coverage. Following the launch of the report, WHO and UNICEF developed a Global Action Plan and have convened meetings on evidence generation, monitoring, facility based improvements and advocacy for water, sanitation, and hygiene in health care facilities.

Primary leadership & direct action

Primary coordination & cooperation with

other sector

Environmentalhealth

in health-carefacilities

Health-protectingnorms & regulations

Response toemerging threats& opportunities

Health ininter-sectoral

policies

Outbreaks ofenvironment-

mediateddiseases

Environmentalhealth in health

programs

The Water Institute conducted a cross-sectional study of rural health care facilities in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. The objective was to determine the extent of access to improved water, sanitation, and handwashing facilities. We found 74% of health care facilities used an improved water source (one protected from contamination). Boreholes were most common in Ethiopia, rainwater in Kenya, and piped–into-yard in Rwanda and Mozambique. Four to 52% of health care facilities reported also using alternative improved sources. We also found that 66% (Ethiopia) to 96% (Zambia) of facilities have improved sanitation (that separates excreta from human contact), most commonly pit latrines with slabs or ventilated improved pit latrines. However, only 15% reported water, soap, and hand drying materials, which are critical for infection prevention. Overall, we found that 10% have consistent access to all three basic services.

PROJECTS


Water, sanitation, and hygiene in rural health facilities in Sub-Saharan Africa: six-country cross-sectional study (World Vision)

Baseline Assessment of Water, Hygiene and Sanitation (WaSH) in Health Care Facilities in Malawi (P&G Children’s Safe Drinking Water Program)

Generating evidence for advocacy Improving the status of water sanitation and hygiene in health care facilities (Wallace Genetic Foundation)

Report on the Status of WaSH and Environmental Conditions in Health Care Facilities (WHO)

Technical assistance to UNICEF Pacific to contribute to establishing regional baselines for post 2015 WaSH sector monitoring in Fiji Vanuatu and Solomon Islands (UNICEF)

30

Little is known about the status of water, sanitation, and hygiene in non-household settings such as schools, health care facilities, and workplaces in low- and middle-income countries. We reviewed international standards and monitoring initiatives; developed the first typology of non-household settings; and assessed the viability of monitoring these settings using contemporary data and systems. We found monitoring in schools and health care facilities to be the most viable. Our findings contributed to the inclusion of schools and health care facilities in SDG targets and monitoring.

PUBLICATIONS


Monitoring Drinking Water, Sanitation, and Hygiene in Non-Household Settings: Priorities for Policy and Practice.

More Health for your Buck: Health Sector Functions to Secure Environmental Health. Eva A. Rehfuess, Nigel Bruce, and Jamie Bartram. 2009. Bulletin of the World Health Organization. 87 (11): 880-882.

How Health Professionals Can Leverage Health Gains from Improved Water, Sanitation and Hygiene Practices. Jamie Bartram and Jennifer Platt. 2010. Perspectives in Public Health. 130 (5): 215–221.

Beyond Direct Impact: Evidence Synthesis Towards a Better Understanding of Effectiveness of Environmental Health Interventions. Eva A. Rehfuess and Jamie Bartram. 2013. International Journal of Hygiene and Environmental Health. 217 (2-3): 155–159.

Lack of Toilets and Safe Water in Health-Care Facilities. Jamie Bartram, Ryan Cronk, Maggie Montgomery, Bruce Gordon, Maria Neira, Edward Kelley, and Yael Velleman. 2015. Bulletin of the World Health Organization. 93: 210.

WaSH Policy Research Digest, Issue 2: WaSH in Healthcare Facilities. Ryan Cronk, Erik Harvey, and Ibrahim Kabole. 2015. The Water Institute at UNC.

Water, Sanitation and Hygiene in Health Care Facilities: Status in low and middle income countries and way forward. Ryan Cronk and Jamie Bartram. 2015. Geneva: World Health Organization.

A Systematic Review of Waterborne Infections from Nontuberculous Mycobacteria in Health Care Facility Water Systems. Trudy Li, Lydia S. Abebe, Ryan Cronk, and Jamie Bartram. 2016. International Journal of Hygiene and Environmental Health. In Press.

Microbial contamination of drinking water sources in non-household settings: a systematic review. Lydia Abebe, Andrew J. Karon, Andrew Koltun, Ryan Cronk, Robert E.S. Bain, and Jamie Bartram. 2017. International Journal of Environmental Research and Public Health. Under Review.

Water, sanitation, and hygiene in rural health care facilities: A cross-sectional study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda and Zambia. Amy Guo, James Bowling, Jamie Bartram, Georgia Kayser. In Press. American Journal of Tropical Medicine and Hygiene.

Ryan Cronk, Tom Slaymaker, and Jamie Bartram. 2015. International Journal of Hygiene and Environmental Health. 218 (8): 694-703

31


Over 1.8 billion people lack safe drinking water. Many more do not have a reliable service. In low-income countries, urban population growth is a major challenge, as is aging infrastructure in high-income countries. In all countries, small water supplies often fail and are more frequently contaminated.

Safe and reliable drinking water is a human right, and this is increasingly reflected in national and international targets. We see concrete opportunities to improve health and wellbeing by accelerating the shift to higher service levels, particularly piped systems that deliver water to households, and implementation of lessons learned about extending and improving services. Higher levels of service (piped water) contribute far more to health and wellbeing than lower levels of service (community wells).

Our research explores the health and other benefits of different water services, identifies inequalities and their consequences, tests technologies and strategies that can help to improve drinking water systems and services to benefit health, and analyses the impacts of policies and regulations.

Our distance learning courses on Water Safety Planning, launched in 2013, has been delivered five times to over 75 mid-career professionals on six continents. The course describes the steps and tools needed to implement a water safety plan, as well as case studies, assessments, and examples of impacts.

DRINKING WATER

Improving water systems to deliver better levels of service and improvements to health, wellbeing,

and economy.


33

Insight: Proving the Effectiveness of Water Safety Plans (WSPs) in Iceland

In 2012, collaborating with partners in Iceland, we produced the first evidence that the implementation of WSPs in developed nations provides quantifiable management, compliance, and health benefits.

Ten years after the introduction of Icelandic regulations for preventive management of water safety, we matched information on the introduction of Hazard Analysis Critical Control Points (HACCP)/WSPs with water-system records on water quality and disease data from health clinic reporting. Remarkably, we found the population with WSPs was 14% less likely to develop clinical diarrhea. Comparing diarrheal disease with respiratory disease data strengthened the conclusion that the reduction in diarrheal incidence was attributable to WSP implementation.

That these health gains were achieved in a developed nation attention is noteworthy. Iceland is unusual in having water catchments with limited human impact and in not chlorinating drinking water. Our evidence suggests that WSP implementation may also benefit other developed nations; we are exploring the health and water quality impacts of WSPs in Spain and France and opportunities and obstacles to the application of WSPs in North Carolina.

Impact: Improving the Regulation, Monitoring, and Quality of the Packed Water Industry in Sierra Leone (Adam Smith International)

Production and consumption of packaged water in West Africa has risen dramatically. With FOCUS 1000 we assessed packaged water quality in Sierra Leone, reviewed the legal landscape, and developed a regulatory framework.

We found 18% of packaged water samples from manufacturing facilities and 24% from points of sale were contaminated with feces. However, while often failing standards and international guidelines, they were safer, with lower levels of E. coli, than available alternatives. We recommended improving regulation and increasing education among manufacturers about water quality testing and good manufacturing practices.

Our legislative review found overlapping mandates, duplicated efforts, and little collaboration between government institutions. Our proposed regulatory framework differentiated roles for stakeholders and comprehensive regulations for packaged water products. To facilitate roll out, we developed an implementation guide, including tools for capacity building of regulators and manufacturers and a public awareness campaign.

Diarrhea incidence in health care facilities before and after Water Safety Plan implementation

Collaborating with the Universities of Leeds and East Anglia and supported by the UK Department for International Development (DfID), we investigated the relationship between water access, domestic water use, and health. We prepared a systematic literature review and ran field studies in Ghana, South Africa, and Vietnam. Finding an association between adverse musculoskeletal outcomes and water carriage for the first time, our research provides powerful evidence of the value of in-home water access.

PROJECTS


Public Health and Social Benefits of At-House Water Supplies (UK DfID)

Evaluation of ProCleanse Technology for Treatment of Drinking Water (ProCleanse)

Identifying Barriers and Levers to Advancing Household Water Treatment and Safe Storage (HWTS) to Scale (PATH and UNICEF)

Integrated Water Quality and Self-Supply Study for MWA Phase 1 and Phase 2 in Ethiopian Kebeles (Millennium Water Alliance)

Solar Water Pumping and Disinfection Initiative (World Vision)

Transformative Use of Chitosan as a Coagulant-Flocculant and Filter Aid to Improve Drinking Water (University of North Carolina, Gillings Innovation Laboratory)

Virtual Learning on Field-based Drinking Water (Alaska Native Tribal Health Consortium)

Feasibility of Implementing Water Safety Plans in North Carolina (National Environmental Health Association/U.S. Centers for Disease Control and Prevention)

Health Based Targets for Drinking-water Safety and Regulation (UK Department for Environment, Food and Rural Affairs (DEFRA))

HWTS Network: UNC Support to WHO and Others (P&G Children’s Safe Drinking Water Program)

Water Safety Planning: Impacts in Small Municipal and Private Water Supply Systems (National Environmental Health Association/U.S. Centers for Disease Control and Prevention)

The Last Mile of Safe Drinking Water Delivery (International Association of Plumbing and Mechanical Officials)

Water Safety Planning Tool Evaluation (Health Canada)

34

We created models to predict the proportion of different types of water sources that are fecally contaminated, for more accurate accounting of “improved” versus “unimproved” water sources. We found that 3 billion (46%) of the 2010 global population consume unsafe water. This is far more than the 2010 official WHO/UNICEF estimate of 783 million (11%) using unimproved sources. This research suggests a need for global action to close the water safety gap.

PUBLICATIONS


Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Water Safety and Inequality in Access to Drinking-water Between Rich and Poor Households. Hong Yang, Robert Bain, Jamie Bartram, Stephen Gundry, Steve Pedley, and James Wright. 2012. Environmental Science and Technology. 47 (3): 1222–1230.

Domestic Water and Sanitation as Water Security: Monitoring, Concepts and Strategy. David J. Bradley and Jamie K. Bartram. 2013. Philosophical Transactions of the Royal Society A: Mathematical, Physical, & Engineering Sciences. 371(2002): 20120420.

Global Assessment of Exposure to Faecal Contamination Through Drinking Water Based on a Systematic Review. Robert Bain, Ryan Cronk, Rifat Hossain, Sophie Bonjour, Kyle Onda, Jim Wright, Hong Yang, et al. 2014. Tropical Medicine and International Health. 19 (8): 917–927.

An Examination of the Potential Added Value of Water Safety Plans to the United States National Drinking Water Legislation. Rachel Baum, Urooj Amjad, Jeanne Luh, Jamie Bartram. 2015. International Journal of Hygiene and Environmental Health. 218 (8): 677-685.

Developing a National Framework for Safe Drinking water – Case Study from Iceland. Maria J. Gunnarsdottir, Sigurdur M. Gardarsson, and Jamie Bartram. 2015. International Journal of Hygiene and Environmental Health. 218: 196–202.

Drinking Water Quality Governance: A Comparative Case Study of Brazil, Ecuador, and Malawi. Georgia L. Kayser, Urooj Amjad, Fernanda Dalcanale, Jamie Bartram, and Margaret E. Bentley. 2015. Environmental Science & Policy. 48: 186–95.

Rethinking Sustainability, Scaling Up, and Enabling Environment: A Framework for Their Implementation in Drinking Water Supply. Urooj Amjad, Edema Ojomo, Kristen Downs, Ryan Cronk, and Jamie Bartram. 2015. Water 7: 1497-1514.

Seasonal Variation of Fecal Contamination in Drinking Water Sources in Developing Countries: A Systematic Review. Caroline Kostyla, Rob Bain, Ryan Cronk, and Jamie Bartram. 2015. Science of The Total Environment 514: 333–43.

A systematic review and meta-analysis of fecal contamination and inadequate treatment of packaged water. Ashley R. Williams, Robert E. Bain, Michael B. Fisher, Ryan Cronk, Emma R. Kelly, and Jamie Bartram. 2015. PLoS ONE. 10 (10): e0140899.

Chemical Quality and Regulatory Compliance of Drinking Water in Iceland. Maria J. Gunnarsdottir, Sigurdur M Gardarsson, Gunnar St Jonsson, and Jamie Bartram. 2016. International Journal of Hygiene and Environmental Health 219(8): 724-733.

Chitosan Coagulation to Improve Microbial and Turbidity Removal by Ceramic Water Filtration for Household Drinking Water Treatment. Lydia S. Abebe, Xinyu Chen, and Mark D. Sobsey. 2016. International Journal of Environmental Research and Public Health. 13(3): 269.

The Flint Water Crisis Confirms That US Drinking Water Needs Improved Risk Management. Rachel Baum, Jamie Bartram, and Steve Hrudey. 2016. Environmental Science & Technology 50(11): 5436-5437.

Literature Review of Associations Among Attributes of Reported Drinking Water Disease Outbreaks. Grant Ligon and Jamie Bartram. 2016. International Journal of Environmental Research and Public Health. 13(6): 527.

On-plot Drinking Water Supplies and Health: A Systematic Review. Alycia Overbo, Ashley R. Williams, Barbara Evans, Paul R. Hunter, and Jamie Bartram. 2016. International Journal of Hygiene and Environmental Health. 219(4): 317-330.

WaSH Policy Research Digest, Issue 3: Handpump Functionality Monitoring. Clarissa Brocklehurst and Jeffrey Goldberg. 2016. The Water Institute at UNC.

Water Safety Plans: Bridges and Barriers to Implementation in North Carolina. Urooj Q. Amjad, Jeanne Luh, Rachel Baum, and Jamie Bartram. 2016. Journal of Water and Health. 14 (5): 816-826.

Water Quality, Compliance, and Health Outcomes Among Utilities Implementing Water Safety Plans in France and Spain. Karen E. Setty, Georgia L. Kayser, Michael Bowling, Jerome Enault, Jean-Francois Loret, Claudia Puigdomenech Serra, Jordi Martin Alonso, Arnau Pla Mateu, and Jamie Bartram. 2017. International Journal of Hygiene and Environmental Health, forthcoming.

Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Morgan, Michael Bowling, Jamie Bartram, and Georgia Kayser. In press. International Journal of Hygiene and Environmental Health.

Robert Bain, Ryan Cronk, Jim Wright, Hong Yang, Tom Slaymaker, and Jamie Bartram. 2014. PLOS Medicine. 11 (5): e1001644.

35


Today, 2.4 billion people lack access to an improved latrine, including a billion who defecate in the open. Most of the sickness and death associated with inadequate water, sanitation, and hygiene is a result of fecal-oral disease transmission, making management of human feces a lynchpin of the water, sanitation, and hygiene challenge. Increasing urbanization concentrates people and wastes into smaller areas, increasing exposure while limiting simple technical options. To date, successful sanitation for the low-income majority is rare, and many fundamental technical and policy questions remain unanswered.

In crowded and poor communities, how effective is sanitation shared between many households? In a given setting, which technologies have what impacts on the threat from human wastes? How can public health hazards from poor sanitation be most practically reduced? What determines the success or failure of widely-used community-based sanitation promotion techniques? How do national and local stakeholders view sanitation; what aspects are most likely to motivate action?

With inter-disciplinary perspectives and experience including engineering, epidemiology, public health policy, microbiology, and qualitative social science research, The Water Institute frames and addresses these and other key questions. While recognizing the many benefits of sanitation, we are driven by a public health agenda to improve quality of life among communities in need. We freely draw from UNC’s microbiological expertise while shaping our work for the field reality of urban and rural settings in a wide range of low- and middle-income countries.

SANITATION

Identifying effective approaches to tackle the sanitation crisis, especially for the urban poor where the services

backlog and the worst of conditions collide.

Identifying effective approaches to tackle the sanitation crisis, especially for the urban poor where the services

backlog and the worst of conditions collide.


37

Insight: Modeling the Hazards of Inadequate Sanitation

In Dhaka, Bangladesh, 99% of human wastes are deposited in some form of toilet but only 2% are safely returned to the environment; the remainder are dumped in open space, drains, or natural water courses. The Water Institute, with support from the Bill & Melinda Gates Foundation, is modeling sanitation-related health hazards at national level. Our work considers the effects of technologies and time upon the numbers of pathogens released to the environment.

This reveals surprising insights. Lengthy storage of wastes, and resultant pathogen die-off, make hygienic pit latrines a straightforward means of pathogen control. By contrast, sewerage can be relatively dangerous due to the short time and poor pathogen removal before discharge. Septic tanks lie somewhere in between. We will next use these models at both a large scale, for country comparison and evaluation over time, and at a smaller scale, to inform local decision making.

Impact: Testing CLTS Approaches for Scalability

Community-Led Total Sanitation (CLTS) is a widely applied participatory approach to eliminate open defecation. While effective in small-scale pilots, questions remain about how to use CLTS at scale. Plan International and The Water Institute worked together to explore three approaches to increase the effectiveness of CLTS at scale in Ethiopia, Ghana, and Kenya, and performed case studies in seven other countries.

We found, for example, that CLTS works much better in some settings than others, yet many programs apply the approach to all communities. To address this, we established protocols for selecting communities where the approach is most likely to work, applying available resources where they will have most impact. We also demonstrated improved outcomes in communities where Plan trained local natural leaders. Plan International and others now use our findings to design and implement more effective interventions.

Simplified “septic tank” schematic

Sanitation facilities are frequently shared between households in underserved urban areas of low- and middle-income countries. The Water Institute, in collaboration with the London School of Hygiene & Tropical Medicine, Georgia Institute of Technology, the University of Florida and Water and Sanitation for the Urban Poor, is exploring the impact of this approach in a rigorous epidemiological study in Maputo, Mozambique. The Water Institute is contributing microbiological expertise, including microbial source tracking, to identify disease transmission pathways in the community, and insight into the study’s implications for policy, programming, and practice.

PROJECTS


Estimating Impacts of an Urban Sanitation Intervention on Child Health in Low-Income Neighborhoods of Maputo, Mozambique (USAID)

Hygiene Effectiveness Levels and Intervention Costs (IRC)

Population Density, Neighborhood-Level Sanitation Access, and Health in Urban Maputo (London School of Hygiene and Tropical Medicine/USAID)

Rapid Detection of Fecal Indicator Bacteria by Enzymatic Hydrolysis of Specific Chromogenic Substrates (North Carolina Sea Grant)

Rapid, On-site Disinfection and Survival of Ebola and Other Viruses in Human Fecal Wastes and Sewage (U.S. National Science Foundation)

Unsafe Human Excreta Return to Environment (Bill & Melinda Gates Foundation)

Assessment of Cost-effectiveness of Hygiene (IRC)

Investigation and Report into Future Options for Global Monitoring of Progress in Water Supply Sanitation and Hygiene in Urban Areas (UNICEF)

Rapid Detection of Fecal Bacteria in Water by Enzymatic Hydrolysis of Specific Chromogenic Substrates (UNICEF)

Rapid Detection of Fecal Bacteria in Water by Improved Enzymatic Methods (UNICEF)

Support to WHO Sanitation Guidelines Development: sanitation technologies fact sheets and policy review (WHO)

Testing Community-led Total Sanitation Approaches for Scalability (PLAN-International USA)

38

Understanding how well sanitation systems provide an effective barrier between people and excreta is a major challenge to progress. Our study offered a substantial step toward a more complete understanding of the extent to which communities actually have improved sanitation. The paper presented our comprehensive, empirical modeling approach, which estimated sewage treatment prevalence and corrected standard accounts by classifying as “improved” only those sewerage systems that treated sewage prior to its discharge to the environment. The result was a more accurate snapshot of progress to date and forecast to guide subsequent investments; we found that official international monitoring statistics claim that 62% of the global population used improved sanitation was too high, and that the actual figure was more like 40%.

PUBLICATIONS


Sanitation: A Global Estimate of Sewerage Connections without Treatment and the Resulting Impact on MDG Progress.

Short-sightedness in Sight-saving: Half a Strategy Will Not Eliminate Blinding Trachoma. Maggie A. Montgomery and Jamie Bartram. 2010. Bulletin of the World Health Organization. 88 (2): 82–82.

A Novel Community-based Water Recreation Area for Schistosomiasis Control in Rural Ghana. Karen C. Kosinski, Jonny Crocker, John L. Durant, Dickson Osabutey, Michael N. Adjei, and David M. Gute. 2011. Journal of Water, Sanitation and Hygiene for Development. 1 (4): 259–268.

Animal Waste, Water Quality and Human Health. Al Dufour, Jamie Bartram, Robert Bos, and Victor Gannon, eds. 2012. Emerging Issues in Water and Infectious Disease Series. Vol. 6. Geneva Switzerland: WHO and London, United Kingdom: IWA Publishing.

Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights? Jamie Bartram, Katrina Charles, Barbara Evans, Lucinda O’Hanlon, and Steve Pedley. 2012. Journal of Water and Health. 10(4): 499–503.

Effective Control of Schistosoma haematobium Infection in a Ghanaian Community Following Installation of a Water Recreation Area. Karen C. Kosinski, Michael N. Adjei, Kwabena M. Bosompem, Jonny Crocker, John L. Durant, Dickson Osabutey, Jeanine D. Plummer, et al. 2012. PLoS Neglected Tropical Diseases. 6 (7): e1709.

A Summary Catalogue of Microbial Drinking Water Tests for Low and Medium Resource Settings. Robert Bain, Jamie Bartram, Mark Elliott, Robert Matthews, Lanakila McMahan, Rosalind Tung, Patty Chuang, and Stephen Gundry. 2012. International Journal of Environmental Research and Public Health. 9 (5): 1609–1625.

Accuracy of the H2S Test: A Systematic Review of the

Influence of Bacterial Density and Sample Volume. Hong Yang, Jim A. Wright, Robert E. Bain, Steve Pedley, Mark Elliott, and Stephen W Gundry. 2013. Journal of Water and Health 11 (2): 173–185.

Scaling up Rural Sanitation in India. Clarissa Brocklehurst. 2014. PLoS Med 11: e1001710.

A controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children: research protocol for the Maputo Sanitation (MapSan) study, Mozambique. Joe Brown, Oliver Cumming, Jamie Bartram, et al. 2015. BMJ Open. 5 (6): e008215.

WaSH Policy Research Digest, Issue 1: Sanitation Subsidies. Clarissa Brocklehurst and David Fuente. 2015. The Water Institute at UNC.

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea. Jonny Crocker and Jamie Bartram. 2016. PLoS Med. 13(5): e1002011.

Impact evaluation of training natural leaders during a community-led total sanitation intervention: a cluster-randomized field trial in Ghana. Jonny Crocker, Elvis Abodoo, Daniel Asamani, William Domapielle, Benedict Gyapong, and Jamie Bartram. 2016. Environmental Science & Technology. 50: 8867–8875.

Revisiting Dignity: The Human Right to Sanitation. Malcolm Langford, Jamie Bartram, and Virginia Roaf. 2016. In The Human Right to Water: Theory, Practice, and Prospects. Malcolm Langford and Anna F. S. Russell, eds. Cambridge University Press.

Teachers and Sanitation Promotion: An Assessment of Community-Led Total Sanitation in Ethiopia. Jonny Crocker, Abiyot Geremew, Fisseha Atalie, Messele Yetie, Jamie Bartram. 2016. Environmental Science & Technology. 50(12): 6517-6525.

WaSH Policy Research Digest, Issue 4: Sanitation and Nutrition. David Berendes, Joe Brown, and Jan Willem Rosenboom. 2016. The Water Institute at UNC.

Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Morgan, Michael Bowling, Jamie Bartram, and Georgia Kayser. In press. International Journal of Hygiene and Environmental Health.

Rachel Baum, Jeanne Luh, and Jamie Bartram. 2013. Environmental Science & Technology. 47 (4): 1994-2000.

39


National and local governments face challenges in financing infrastructure expansion and replacement, developing service delivery models that meet the needs of all users, and regulating service quality. These challenges are faced by low- and high-income countries alike.

Industrialized countries must mobilize financing to replace their aging infrastructure in an equitable and efficient manner. Low- and middle-income countries have the opportunity to explore which service delivery models are best to rapidly expand water and sanitation services that are safe, reliable, and responsive to demographic change and consumer preferences. All governments must design fit-for-purpose models of regulation that protect populations, incentivize efficient, high quality service delivery, and foster innovation. We see important opportunities in synthesizing international experience, explore promising practices, identify knowledge gaps, and evaluate policies intended to enhance service delivery.

The Water Institute works with governments, regulators, utilities, and private service providers to identify barriers to sustainable access to high quality water and sanitation services at scale and actionable opportunities to improve service delivery. We believe that helping governments develop smart governance, promote effective service delivery models, and implement evidence-based policies can accelerate access to high quality water and sanitation services.

GOVERNANCE

Advancing evidence-based policies and enhancing local and national governance and management to ensure

high quality water and sanitation services for all.


41

Insight: Meeting of Senior Finance Ministry Officials on Decision-Making for WaSH

With support from the Bill & Melinda Gates Foundation, The Water Institute and UNC’s Global Research Institute hosted civil servants from the Ministries of Finance of Nigeria, The Gambia, Sierra Leone, Uganda, Liberia, and South Sudan to learn about decision-making and solicit advice on how to make partnership meetings more effective. The dialogue highlighted that water and sanitation institutions are often perceived to be weak, perpetuating reluctance to fund improvement, In particular, fragmentation, lack of actionable data, weak absorptive capacity, a poor record of sustainability, and inability to track and demonstrate progress all created barriers to broader support for investments in the water, sanitation, and hygiene.

Impact: Water pricing and subsidies in Nairobi, Kenya

The increasing block tariff (IBT) is widely used by water utilities, particularly in low- and middle-income countries. This is in part due to the perception that it delivers subsidies to low-income households. In partnership with Environment for Development-Kenya, the University of Nairobi School of Economics, and the Nairobi Water and Sewer Company, The Water Institute examined the distribution of subsidies through IBT in Nairobi. Contrary to conventional wisdom, we found that commercial and high-income residential customers received most subsidies. We also found that residents in Nairobi’s slums, who typically purchase water from public and private kiosks, pay far more for water than customers with a private, piped connection. In response to these findings, Kenya’s National Water Services Regulatory Board (WASREB) reduced the official price for water at public kiosks in Nairobi by half and is considering taking similar action in all water utilities across Kenya.

Share of subsidies delivered to residential water and sanitation customers in different wealth quintiles through the water tariff in Nairobi, Kenya.

African-American communities at the fringes of North Carolina towns and cities lack access to nearby municipal water supplies, putting the population at risk of adverse health effects from inadequate and unreliable drinking water. We provided the first systematic statistical analysis of the role of race in access to municipal water service. In many communities, including the study area of Wake County, African-Americans are significantly less likely than whites to have access to important public health services such as municipal drinking water.

PROJECTS


Racial Disparities in Access to Public Water and Sewer Service in North Carolina (Robert Wood Johnson Foundation)

Protecting Wastewater Treatment Plant Operators from Emerging Pathogens: A Preparedness Protocol and On-Line Decision Support Tool (Water Environment Research Foundation)

Providing Technical Assistance to the Government of Haiti in the Development of a National Strategy on Household Water Treatment and Safe Storage (Avram/U.S. Centers for Disease Control and Prevention/Haitian National Directorate of Water Supply and Sanitation)

UN World Water Development Report 4 (UN World Water Assessment Programme)

Understanding Processes for Sustainability in Community-Managed Water Supply Systems (World Vision and Wallace Genetic)

Water and sanitation markets in the Pacific understanding demand and sustainable marketplaces (International Water Centre-Austalian Department of Foreign Affairs and Trade)

Water Safety Planning measuring gains and implementing effective practices (Suez Environnement)

Water and Sanitation Service Sustainability (UNICEF)

A Decision-Making Tool for Water and Sanitation (U.S. Environmental Protection Agency People, Prosperity, and the Planet Award)

42

Governments use regulations to ensure the delivery of safe drinking water. Nevertheless, sporadic contamination, endemic waterborne disease, and outbreaks still occur. This study is a comparative analysis of water safety plans and current US drinking water regulations. We found that regulations overlap with WSPs in describing the water supply system and defining monitoring and controls, but gaps exist in team procedures and training, internal risk assessment and prioritization, and management procedures and plans. We recommend filling these gaps to improve drinking water quality and human health both locally and nationally.

PUBLICATIONS


An Examination of the Potential Added Value of Water Safety Plans to the United States National Drinking Water Legislation.

Analysis of Water Safety Plan Costs from Case Studies in the Western Pacific Region. Zai Kang Chang, Mien Ling Chong, and Jamie Bartram. 2013. Water Science & Technology: Water Supply. 13 (5): 1358-1366.

Circuit Rider Post-construction Support: Improvements in Domestic Water Quality and System Sustainability in El Salvador. Georgia L. Kayser, William Moomaw, Jose Miguel Orellana Portillo, and Jeffrey K. Griffiths. 2014. Journal of Water, Sanitation and Hygiene for Development. 4 (3): 460–470.

Translating the Human Right to Water and Sanitation into Public Policy Reform. Benjamin M. Meier, Georgia L. Kayser, Jocelyn G. Kestenbaum, Urooj Q. Amjad, Fernanda Dalcanale, and Jamie Bartram. 2014. Science and Engineering Ethics. 20 (4): 833-848.

Drinking Water Quality Governance: A Comparative Case Study of Brazil, Ecuador, and Malawi. Georgia L. Kayser, Urooj Amjad, Fernanda Dalcanale, Jamie Bartram, and Margaret E. Bentley. 2015. Environmental Science & Policy. 48: 186–95.

Rethinking Sustainability, Scaling Up, and Enabling Environment: A Framework for Their Implementation in Drinking Water Supply. Urooj Amjad, Edema Ojomo, Kristen Downs, Ryan Cronk, and Jamie Bartram. 2015. Water 7: 1497- 1514.

Water Safety Plans: Bridges and Barriers to Implementation in North Carolina. Urooj Q. Amjad, Jeanne Luh, Rachel Baum, and Jamie Bartram. 2016. Journal of Water and Health. 14 (5): 816-826.

The Flint water crisis confirms that US drinking water needs improved risk management. Rachel Baum, Jamie Bartram, and Steve Hrudey. 2016. Environmental Science & Technology. 50(11): 5436-5437.

Water and sanitation service delivery, pricing, and the poor: An empirical estimate of subsidy incidence in Nairobi, Kenya. David Fuente, Josephine G. Gatua, Moses Ikiara, Jane Kabubo-Mariara, Mbutu Mwaura, Dale Whittington. 2016. Water Resources Research. 52: 4845-4862.

WaSH Policy Research Digest, Issue 5: Water Tariffs and Subsidies. Clarissa Brocklehurst and David Fuente. 2016. The Water Institute at UNC.

Rachel Baum, Urooj Amjad, Jeanne Luh, and Jamie Bartram. 2015. International Journal of Hygiene and Environmental Health. 218 (8): 677-685.

43


Functions of the

WATER INSTITUTE

FUNCTIONS


45

We have four functions that support our leadership in water, health, and development, using science to inform good practices, efficient

programming, and effective policy. For each function, we track indicators for inputs, outputs, and impact that inform our strategic

planning and program implementation.

We address knowledge gaps that hamper progress in water, sanitation, hygiene, health, and development. Our research contributes to evidence-based policy-making and decision-taking and is responsive to our partners in the scientific, policy, programming, and practitioner communities, both domestically and internationally.

We communicate, translate, and mediate between researchers and decision-makers, providing access to and assisting in the co-production of relevant and up-to-date knowledge in order to protect and improve human health worldwide and predict and prevent emerging risks.

We bring together people and institutions from diverse disciplines and sectors through partnerships and events, enabling collaboration in solving critical problems in water, health, and development.

We use pedagogical strategies, ranging from small, hands-on collegiate courses to innovative distance learning programs, to help meet the global need for relevant, accessible training for water and health professionals. Through multidisciplinary coursework, students benefit from the knowledge base, experience, and expertise of our faculty, staff, collaborators, and fellow students.

Teaching and Learning

Knowledge Management

Research

Networking and Partnership

Our research is guided by the principle of providing actionable evidence to policy-makers, program managers, practitioners, and academia.

Our researchers deliver breadth, depth, and scientific excellence. In emphasizing partnerships with implementers and by welcoming visiting or collaborating scholars, we seek to address concrete problems and to identify and respond to trends and emerging issues in water, health, and development.

In our first six years, we especially focused on evidence to support policies during the changeover from the Millennium Development Goals to the Sustainable Development Goals in 2015. We also worked with implementers to understand “what works” in real-world programs and different contexts, yielding insights which are already being applied by our partners around the world.

We seek to understand our trajectory by tracking annual trends in our successful proposals, both in terms of total dollars and average value.

RESEARCH

Purpose

Inputs

46


Value of research awards by year received

Research expenditure serves as an indicator of our level of research activity. We also track the number of our new publications by year as a simple measure of research output.

Our research impact can be found throughout the global policy, programming, practice and scholarly conversations. Citations in scholarly journals and policy and grey literature provide a simple means to track our influence and impact. We are exploring the use of altmetrics and advanced web analytics to better understand which of (and how) our documents are taken up by the policy, programming, practitioner and scientific communities.

Outputs

Impact

47


Research expenditures by year

Publications, citations, and M Quotient by year

We will continue to prioritize research on areas of achievable impact. We have proven impact on policy (see our Governance and Regulation [pages 40–43], and International Policy and Monitoring [pages 24–27], focus areas), and our operational research, which spans many focus areas, is a model on which we will build further. Both show the value of our strategic decision to partner with implementers.

FUTURE STRATEGY

48


Our decision to proactively identify focus areas that are justified by problem definition, opportunity

characterization, and impact potential has been valuable in internal decision-making about where

to dedicate energies. We will continue to apply these criteria rigorously.

We will build relationships with key constituencies to better define research problems, establish collaborative teams to probe them, and communicate findings efficiently. Looking forward, we will increase the links between our Research and Networking and Partnership (pages 46–50) functions to improve both problem identification and communication. Because our research is designed to provide actionable evidence to defined stakeholders and because trusted evidence is often co-produced, we have prioritized the development of a Knowledge Management and Communications team (pages 58–60), who are instrumental in ensuring our target audiences are identified and understood and our research is widely accessible. Our research also supports our Teaching and Learning (pages 54–57) activities in the field of Continuous Quality Improvement, where objective field data are used in a rapid-cycle feedback loop to fuel real-world improvements. We are leaders of this approach in water, sanitation, and hygiene and we will continue to develop and apply CQI.

There are no “one-size-fits-all” solutions to water, sanitation, and hygiene challenges. Any given approach to behavior change or service delivery will have varying costs and outcomes in different settings, and thus, different impacts. Ideally, program managers and practitioners would be able to choose an approach that is suited for their objectives, available resources, and the context in which they work. However, much existing evidence does not support such decision making.

Operational research is intended to address widespread recurring challenges to implementation, and to provide evidence with immediate implications for policy, programming, and practice. It involves partnerships between researchers and implementers, and analysis of context and process to answer important questions like: “how can the efficiency or effectiveness of this program be improved?”

The Water Institute worked with Plan International for five years on operational research of community-led total sanitation (CLTS). We found that CLTS can have a major impact on sanitation practices, costs are higher than previously reported but there is room for increased efficiency, engaging local actors can improve effectiveness, and CLTS is an appropriate approach in certain settings but ineffective and inefficient in others. Through a series of learning events, we developed a number of key messages and implications together with Plan International, which they are now using to redesign their global programs.

OPERATIONAL RESEARCH


49

We bring together individuals and institutions from diverse disciplines and sectors, empowering them to collaborate to solve critical global issues in water that improve health and development in North Carolina and around the world. We connect the public and private sectors, and leverage our relationships to foster learning, collaboration, and advancement through our conferences, sustained partnerships within UNC and beyond, and participation in coalitions. Our efforts are designed to add value and enable the programming, policy, practice, and research communities to develop effective ideas and approaches that can be put into action.

Today’s most pressing issues in water are multidimensional, impacting health, livelihoods, and human development in a variety of ways. The Water Institute partners with experts across disciplines within UNC and beyond to ensure we are approaching challenges in a holistic, informed manner. Many UNC partners have worked with The Water Institute through formal affiliation and collaboration on projects. Our current UNC partners come from across the Gillings School of Global Public Health and from the Institute for Marine Sciences, Institute for the Environment, School of Government, and elsewhere.

UNC faculty and staff engage with us as affiliates and collaborators. Affiliates are immersed in the day-to-day activities of The Water Institute and contribute regularly to our value and impact. Collaborators work with us on specific activities, typically research projects and conferences. For example, our annual Water Microbiology Conference is managed by our collaborators Professors Rachel Noble, Mark Sobsey, and Jill Stewart. They drive the development of the conference program and ensure the conference strengthens the water microbiology community.

NETWORKING AND PARTNERSHIP

Purpose

Inputs

50


UNC faculty and staff partners by year

We have held ten international conferences: six on Water and Health: where science meets policy, three on Water Microbiology, and one on the Water, Food, Climate and Energy Nexus. With each Water and Health Conference we have seen increases in both quality and quantity of abstract submissions, side event proposals, sponsorship, and conference attendance. Seven hundred people attended the 2015 Water and Health Conference, and we aim to stabilize the size of the conference at or below that number going forward.

We are especially proud that the conferences are developing into communities. The sustained and growing interest we continue to see in Water and Health and Water Microbiology demonstrate our ability to provide a gathering place for these communities to come together, exchange ideas and collaborate. Instrumental in the success of the conferences is our convening model, which encourages open engagement, learning, discussion and partnership.

The Water Institute is actively engaged in The Sanitation and Water for All Partnership (SWA) and the U.S. Water Partnership (USWP). Both are influential coalitions, mobilizing and advocating that resources be put toward improving global access to sustainable water, sanitation, and hygiene.

Impact

The Water Institute participates in lasting partnerships for joint activities to achieve agreed-upon ends or to service a community or network. Collaboration allows us and our partners to extend our reach, to benefit from the interactions with one other and to make best use of available resources.

In our longest-established partnership, we have been supported for six years by P&G’s Children’s Safe Drinking Water Program to manage the communication activities of WHO and UNICEF’s Household Water Treatment and Safe Storage (HWTS) Network. The mission of the Network is to “contribute to a significant reduction in waterborne disease, especially among vulnerable populations, by promoting household water treatment and safe storage as a key component of water, sanitation and hygiene programmes.” Through our communications activities we have helped the Network by developing and delivering its newsletter, re-developing the Network’s website, creating and giving presentations at global meetings, and contributing to the research and development of learning briefs.

We also have wide-ranging partnerships with the International Association of Plumbing and Mechanical Officials (since 2010), IRC (since 2014), Aquaya (since 2015), and UNICEF Pacific (since 2015). In each of these relationships we are working to develop lasting engagement which will help achieve our shared goals.

Outputs

51


Timeline of formal partnerships

In 2014 and 2015, The Water Institute served on the SWA Steering Committee as the representative of the Research and Learning constituency and remains an active member of the constituency contributing to its efforts to strengthen the knowledge base into which SWA members can tap. We are active in SWA’s global monitoring and harmonization task team, which focuses on improving efficiency by harmonizing and reducing duplication of efforts of various actors.

The Water Institute is a founding member of the USWP and for two years served as Chair of the membership subcommittee and as a member of the Steering Committee. USWP has now evolved into not-for-profit (501(c)(3)) organization and The Water Institute continues as a member, providing expertise and guidance to those entities seeking support on global water security issues through USWP and collaborating with other members to advance water, health, and development.

52

THE WATER INSTITUTE AT UNC | SIX YEAR REVIEWN

um

ber

of

Paid

an

d C

om

plim

en

tary

Reg

istr

ati

on

s

Conference registration by year

We will continue to work through partnerships and coalitions to solve critical global issues in water that improve health and development in North Carolina and the world. We will continue to expand our network to include new audiences and entities and will work to develop partnerships inside UNC and beyond the university that will allow us to extend the reach and influence of The Water Institute. We intend to expand our work with faculty collaborators and affiliates. We benefit from having porous boundaries that allow us to partner with diverse collaborators, from across UNC and around the globe; we will continue to forge those relationships.

We will consolidate and strengthen the leading position of the Water and Health Conference. Our strategy is to enable the Conference to grow organically by enabling new initiatives that address cutting edge, topical issues. Topics for presentations, panel discussions, and side events will respond to the demands of the community and engage with the priorities of international networks. For example, we are developing a conference focused on domestic water and health that will include North Carolina specific topics in response to participant requests. We will further develop the Water Microbiology Conference and work to establish partnerships that will support this gathering. We also intend to develop and offer new events such as one-day seminars and conferences that take one new topics and address the gaps we see in the water, health and development community.

FUTURE STRATEGY


53

We will continue to work through partnerships and coalitions to solve critical global issues in water that improve health and development in

North Carolina and the world.

As The Water Institute addresses issues at the intersections of, diverse sectors, we are well positioned to encourage an exchange of information and insights amongst researchers, practitioners, governments and the private sector. We will be focused on developing “communities of practice,” – hubs of information and vehicles for idea exchanges around related issues.

Safe and reliable water, sanitation, and hygiene services require “human capital”: people with the knowledge, skill, and judgment to develop policies and implement programs which provide socially, economically, and technically sustainable services. A detailed survey of just 10 countries identified a shortfall of nearly 800,000 educated professionals in drinking water and sanitation, and emerging technologies and challenges demand a workforce with flexibility and creativity.

In our first six years, we have experimented with different approaches to building capacity in research, professional skills, policy, and programming. We have worked with partners from within and external to UNC to understand their needs, exploring the potential of traditional residential collegiate courses, intensive on-site workshops, and interactive, digital learning. To meet the needs of our online participants, we built and adapted a digital learning platform for low-bandwidth settings. With each iteration of our educational offerings, we learn new ways to bring to the online environment the rigorous engagement among teachers and students characteristic of our face-to-face teaching at UNC.

We have contributed substantively to enhancing water-related student opportunities within UNC. During the school year, we host lunch seminars for students, faculty and staff. These provide students with a supportive and challenging setting to present and receive constructive criticism their research, allow visitors to meet us and present their work, and help staff stay abreast of ongoing projects.

We are well-placed to contribute to the effort to build the needed capacities. We support graduate education and professional development both at UNC and through online distance learning initiatives. In North Carolina and worldwide, we have a proven record of providing multidisciplinary perspectives and education, teaching engineers about health and public health workers about water, sanitation, and hygiene technologies.

Students affiliated with The Water Institute are interested in water-health-environment linkages, typically work in one or more of our focus areas and have affiliated faculty advisors. Many of our affiliated students receive partial or full financial support, and the number of students supported has grown.

TEACHING AND LEARNING

Purpose

Inputs

54


The Water Institute has a growing number of student affiliates who benefit from opportunities to work on real-world problems in the field with implementing partners under the guidance of widely-recognized faculty.

We have developed 19 professional development learning modules which together comprise two professional development courses. The Monitoring, Evaluation and Learning course includes modules on evaluation design, sampling and analysis of data, surveys, and research methods. Modules in the Water Safety Plans course include identifying hazards and hazardous events, maintaining improvement plans, and monitoring control measures.

Outputs

55


Water Institute student financial support

Water Institute Affiliated Students

We recognize that the learning needs of the water, health, and development communities are multi-tiered, so our future strategy includes several levels of service. We are developing customized training programs to address the needs of our partner organizations. We will create a portfolio of low-cost and easily accessible online, face-to-face, and blended professional development courses. We are also working across the University, within the Gillings School of Global Public Health and the Department of Environmental Sciences and Engineering to increase course offerings. In this way, regardless of whether a learner is seeking a basic introduction to water, health and development, professional training to improve their monitoring skillset, or an advanced degree with a focus on water and sanitation, we will be able to meet their needs.

FUTURE STRATEGY

The Water Institute’s online learning courses have provided professional training for water, development, and health practitioners from 57 countries. We have had 122 participants complete one or more of our online course modules.

Impact

56


Course participants by region

Training and capacity building are long established and critical components of policies, strategies, and programs world-wide. However, there is a substantive human resources capacity gap (both in terms of personnel and skills) in water, sanitation, and hygiene, which will only widen with population growth and the ambitious targets introduced with the Sustainable Development Goals. In response, the need for training will also increase. Unfortunately, many existing training programs do not include self-evaluation, meaning substantial investments of resources often have questionable outcomes.

The few published training evaluations in water, sanitation, and hygiene tend to lack rigor, and do not draw on the extensive evidence that exists outside of the field. The Water Institute developed a conceptual framework for evaluating training and applied it in partnership with Plan International to a CLTS management training program in Kenya. The framework and evaluation results were published in the journal Social Science & Medicine. We found that training programs for government officials could increase their impact by integrating soft skills such as advocacy, partnership, and supervision that are applicable across public health sectors. Our conceptual framework can support design of effective training programs and more rigorous training evaluations.


57

TRAINING EVALUATION

Attitude & motivation

TARGETOUTCOMES

Traineeinfluences

Contextinfluences

Attitude & motivation

Ability

Training designOrganizational

factorsExternal factors

LearningIndividual

PerformanceImproved

Programming

Our knowledge management and communications activities link evidence to sound policy, efficient programming and effective practice. We deliver knowledge in a timely manner to those who can learn from it, use it, and expand on it. We communicate, translate, and mediate to make information, both from our own work and from others, intelligible and useful as well as credible and salient.

We encourage co-production and collaboration between those who seek and those who have knowledge, such as through our operational research with partners in policy or practice (page 45). We have a demonstrated commitment to transforming research into meaningful findings and recommendations that can be put into action.

Our longest-standing knowledge product is our monthly email newsletter. Our website lists and describes our projects and publications and links to information portals for communities of practice on monitoring, evaluation, and learning (MEL), community-led total sanitation (CLTS), and household water treatment and safe storage (HWTS). Since 2011, we have collaborated with the International Water Association in publishing the quarterly Journal of Water, Sanitation and Hygiene for Development. In 2015 we launched the quarterly WaSH Policy Research Digest, which provides distilled and accessible evidence on subjects of concern to in-country decision makers. We are beginning to publish project datasets in an open repository called the UNC Dataverse. We frequently facilitate and coordinate more specialized knowledge management activities with partners, ranging from webinars and online presentations to international meetings.

The inputs to our knowledge management and communications work are outputs of the research (page 47), networking and partnerships (page 51), and teaching and learning (page 55) functions, documented in the corresponding sections of this review.

KNOWLEDGE MANAGEMENT AND COMMUNICATIONS

Purpose

Inputs

58


The Journal of Water, Sanitation and Hygiene for Development’ achieved a 2015 impact factor of 0.8, and it is listed in Thomson Reuters’ Web of Science, an index of scholarly and influential works. The Journal has published 271 articles across 21 issues.

The Water Institute has sent 61 newsletters since 2010. It has been our most consistent and effective communication channel. Our delivery rates (percentage of intended recipients to whom the email was successfully delivered) and open rates (percentage of recipients who opened the email at least once) meet benchmarks for the academic and non-profit sectors.

Impact

Outputs

Monthly Newsletter Recipient Count, Delivery and Open Rates, 2010-2016

Impact factor is not awarded by Thomson Reuters for the first two years after a journal is first published, and is published yearly for the previous calendar year.

59


2011 4 24 —

2012 4 29 —

Calender Year Issues Articles Published Impact Factor

2013 4 68 0.509

2014 4 68 0.439

2015 4 63 0.799

2016 4 69 —

*Note: open rate is estimated for 2010-2011 and 2012-2013 due to software inconsistencies

We understand that scientific insights can influence policy, programming, and practice for the better when the information conveyed is seen by key stakeholders as credible, salient, and legitimate. We have a proven track record of producing high-quality knowledge products and events. We will continue to work to carefully identify and understand our audiences and better identify and evaluate impact. We will grow our subscriber database while leveraging communications and networking activities to improve the quality of data and the relevance of messaging. We will continue to support communities of practice through convocation, mediation, and strategic leadership.

FUTURE STRATEGY


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3 Boundary organizations “act as intermediaries between the arenas of science and policy.” For more information on “boundary work,” please reference: Guston, David H. “Boundary Organizations in Environmental Policy and Science: An Introduction.” Science, Technology, & Human Values 26, no. 4 (2001): 399–408.

We will actively identify the needs of our stakeholders and tailor and target outputs accordingly. We will

enrich and improve the interactive qualities of our website, social media pages, and other digital platforms.

We will continue to diversify our knowledge products though the development of audiovisual content and

interactive web applications.

We will continue to encourage open and responsible publication of datasets in order to support collaboration across institutional boundaries. We have introduced Continuous Quality Improvement with great success (page 17), and we will use the same model of rapid cycles of design, development, deployment, and review and to target our materials, rapidly iterate as a “boundary3 organization”, and ensure that we provide academic leadership.

Our

PEOPLE

Dr. Jamie Bartram Director, The Water Institute

Jamie is the Don and Jennifer Holzworth Distinguished Professor in UNC’s Department of Environmental Sciences and Engineering. He has 30 years of experience in international policy, research, and advisory work in public health and disease prevention. Before coming to UNC, he spent ten years as coordinator of Water, Sanitation, Hygiene and Health at the World Health Organization headquarters.

Dr. Pete Kolsky Associate Director, The Water Institute

Pete is a Professor of the Practice in Environmental Engineering. As Associate Director, he plays major roles in our teaching and sanitation-related work. A former senior water and sanitation specialist at the World Bank who has also worked directly for the Government of Mozambique, NGOs, the University of London, and US consulting firms, he brings 40 years of experience in water, sanitation, and health in low- and middle-income countries.

Kaida Liang Director of Projects

Kaida is Director of Projects and Focus Area Lead for Monitoring, Evaluation, and Learning for the Water Institute. She has nearly 20 years of experience managing water, sanitation and hygiene programs in over 30 countries. Prior to joining The Water Institute, she served as a lead on the UNC-led, USAID-funded WaterSHED-Asia project, and for seven years prior to her MPH, she managed water programs in development and humanitarian response settings in Asia, Africa, Latin America, and the Middle East.

Ron Ross Director of Administration and Operations

Ron oversees business, development, and human resources for The Water Institute. He contributes to strategic planning, including oversight of the Institute’s management structure and of its Board of Advisors. He is a retired Navy veteran who brings over 30 years of operational and administrative experience.

Marissa Streyle Director of Networking and Partnerships

Marissa oversees conferences and other networking events and partnerships for The Water Institute. She works closely with our partners and collaborators to ensure our continued success in research and knowledge development in water, sanitation, health, and development. Marissa has more than ten years of experience in international development policy.

DIRECTORS


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Lydia Abebe

Lydia is the lead scientist for the Health Systems and Healthy Environments focus area. She works at the intersection of water, sanitation, and hygiene (WaSH) in health care facilities, with an emphasis on the links between science, policy, and practice, in both developed and developing countries. Her interests include water treatment technologies, health system activities on water and sanitation, and monitoring and impact evaluation of interventions. She also leads laboratory research on developing and evaluating household level water purification technologies, and contributes to the development of surveillance methods for the detection of antibiotic resistant bacteria in the environment. Lydia received her doctorate in Civil and Environmental Engineering from University of Virginia.

David Fuente

David is an applied environmental economist and planner who leads The Water Institute’s work on Governance and Regulation and Adaptation to Climate Extremes. He has extensive experience working with water utilities and water regulators on water pricing, utility regulation, and utility management in Egypt, India, and Kenya. He has served as a consultant to several institutions including the SIDA-funded Environmental for Development Initiative, USAID, the Global Development Network, and the FAO. Prior to UNC, He was Program Head for Infrastructure Finance and Governance at the Centre for Development Finance (CDF) in India where he led a team of 17 researchers and a portfolio of seven initiatives to promote increased access to infrastructure and services across rural and urban India.

Jeanne Luh

Jeanne leads The Water Institute’s work on International Policy and Monitoring, was co-lead for Adaptation to Climate Extremes, and is now lead for Drinking Water. Jeanne is an environmental engineer whose expertise spans water quality, treatment, and policy for water and sanitation access. At The Water Institute, she led projects related to progress toward universal access to safe water and sanitation (through the development of an index measuring progressive realization of the human right to water and the re-assessment of global progress toward universal sanitation), the feasibility of implementing Water Safety Plans in the United States, and vulnerability of loss of access to drinking water due to extreme weather events – both at the global and sub-national level. Jeanne received her MS and PhD in Environmental Engineering from the University of Illinois, Urbana-Champaign.

Two directors, Pete Kolsky, and Kaida Liang, also serve as focus area leads for Sanitation and for Monitoring, Evaluation, and Learning, respectively.

FOCUS AREA LEAD SCIENTISTS


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STAFF


Jordan Dalton Web and Technology Manager

Jordan is a critical technologist with a background in environmental monitoring, media art, and design. He manages The Water Institute’s technology purchases, develops custom software solutions, assists with data stewardship and analysis, maintains all websites. He consults with Institute projects on information security, visual communications strategy, and technology deployment. Prior to joining The Water Institute, he was director of the digital studio at a mid-sized design agency in Atlanta, GA. He holds a Master of Fine Arts from the Department of Media Study at the University at Buffalo, State University of New York.

Shannan George Training Specialist

Shannan has wide-ranging experience in environmental science as both a practitioner and educator. She was previously the Director of Sustainability at Life University in Marietta, GA. She holds a Master’s Degree in Environmental Science and Public Policy from George Mason University. Her interests include water quality, environmental health and adult education. As a training specialist, she works to develop and implement practical teaching and learning tools for water, development, and health.

A.J. Karon Research Specialist

A.J. graduated with an MSPH in Environmental Sciences and Engineering in 2016, where he focused on water, sanitation, and hygiene in development. Through his graduate research projects, he assessed the enabling factors of behavior-based sanitation and hygiene programs, the efficacy of point of use water treatment technologies, and the prevalence of microbial contaminated drinking water in non-household settings. As a research specialist for The Water Institute, A.J. provides technical expertise to design and conduct high quality program evaluations.

Osborn Kwena Research Specialist

Osborn has 6 years of experience in the implementation of public health research projects as a field practitioner and project manager. His expertise ranges from training and project management to qualitative research and monitoring and evaluation. In his current role at The Water Institute, he develops training materials and improves data for monitoring, evaluation, and learning.

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Emily Madsen Field Researcher

Emily has 10 years’ experience in research on global health and development, with over 2 years based in India. Her work has spanned water, sanitation, and hygiene, women’s health, community-based health interventions, and communications. In her current role, she works with partners to use data for program improvement and capacity building.

Margie Callahan Mazzarella Proposals Coordinator

Margie manages proposal development and submission for The Water Institute’s wide range of sponsors. She contributes 14 years of experience in proposal writing, budgets and submission to US government and international agencies, foundations and corporations on behalf of non-governmental organizations based in the U.S. She has worked in Haiti, Zimbabwe, Benin, Chad, Kenya and Indonesia.

Heather Pace Events Coordinator

Heather manages our annual Water and Health and Water Microbiology conferences, as well as developing new and compelling workshops, seminars, and other events. She brings over a decade of event planning experience to The Water Institute. She holds a Bachelor’s Degree in English Literature from Florida State University and previously managed event finance for Paramount Pictures.

Kate Shields Research Associate

Kate’s research interests lie in the intersection of water, sanitation and hygiene (WaSH), health, and water resource management. Her work includes participatory research on WaSH marketing exchanges, analysis of the enabling environments for WaSH and extreme climate events, and exploration of processes for sustainability in community-managed water supplies. She has worked in Turkey, Scotland, Ecuador, Ethiopia and the Pacific. She holds a Masters of Public Health in Epidemiology and International Health and an MA in Middle Eastern and North African Studies from the University of Michigan.

We are also grateful to all of our past staff members, whose hard work and dedication was vital during The Water Institute’s first six years:

Jen Bogle Enelda ButlerRonna ChanPatty ChuangChris ClineKatie Donohue McMillian

Margo GinsbergKatie HallKris HorvathJessica IzquierdoDenise JohnsonCrystal Ki

Hannah LekerJoe LoBuglioBen MannAshley McKinneyJulia MendenhallJulie Moushon

Alycia OverboRyan RoweDottie SchmittAlec ShannonAshley Williams

FORMER STAFF


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Jianyong Wu (2013 – 2015)Jianyong moved on to a position with USEPA in Research Triangle Park.

Urooj Amjad (2011 – 2014)Urooj is now an instructor/lecturer at Queens College (City University of New York).

Fernanda Dalcanale (2012-2013)Fernanda took a research position at the University of Sao Paolo, Brazil.

Mark Elliott (2010 – 2012)Mark was recruited into a tenure track position at the University of Alabama. He continues to collaborate with us as a Visiting Scholar.

Jeanne Luh (2012-2015)Jeanne continues to work with The Water Institute as a program coordinator and Focus Area lead.

Joe Lobuglio (2009-2012)Joe went on to join the Engineering faculty at the North Carolina School of Science and Mathematics.

Georgia Kaiser (2011-2016)Georgia went on to a project scientist position at the University of California at San Diego.

FORMER POST-DOCTORAL FELLOWS

POST-DOCTORAL RESEARCH FELLOWS


Jonny Crocker

Jonny has worked in over a dozen developing countries conducting research and contributing to water, sanitation, and hygiene projects. He holds a BS from Tufts University and an MS and PhD in environmental sciences and engineering from UNC. His interest in international work began with Engineers Without Borders at Tufts, where he began his work in water and sanitation in rural Tibet. While at UNC, Jonny has worked with governments and NGOs to evaluate and improve water and sanitation programs in Africa, Asia, and Latin America.

Michael Fisher

Mike leverages environmental science and engineering, public health, and implementation science tools to maximize the impact of water and sanitation programs. His work includes developing indicators and tools for improving the monitoring and performance of water and sanitation programs, improving field-level water quality monitoring activities in multiple countries, and researching new technologies for the monitoring and disinfection of water and wastewater in US and international contexts. He has also applied continuous quality improvement methods to water and sanitation programs.

Edema Ojomo

Edema is a chemical and environmental engineer whose expertise is in policy and context analysis related to WaSH programs. Her research focuses on improving planning and implementation practices through examination of the health, policy and cultural implications of WaSH programs. She has worked on and led projects related to household water treatment and safe storage practices, vulnerability assessments of drinking-water systems and adaptation of these systems to climate change, and describing and shaping the enabling environment for drinking-water programs.

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CURRENT WATER INSTITUTE AFFILIATED STUDENTS


Rachel Baum PhD Candidate

Focus: Water system risk management, water resource management, environmental economics

Katie Connolly MSPH Candidate

Focus: Climate change adaptation in water and wastewater utilities

Katy M. Brown PhD Candidate

Focus: Sanitation infrastructure for the management of menstrual hygiene and fecal sludge.

Ryan Cronk PhD Candidate

Focus: Monitoring, Evaluation, and Learning for equitable, sustainable, and safe delivery of drinking water services in developing countries.

Elizabeth Christenson PhD Candidate

Focus: Demographic patterns and potential health and environmental impacts using Geographic Information Systems.

Kristen Downs PhD Candidate

Focus: Sustainability of rural water supply; monitoring for sustainability; geographic equity in planning and implementing water supply.

Students affiliated with The Water Institute are registered students at UNC and have active interest in water-health-development linkages through their own research, Engineers Without Borders (EWB) or other pursuits. Typically, Water Institute students work in one or more of The Water Institute focus areas and with faculty advisors affiliated with The Institute.

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Allison Fechter MS Candidate

Focus: Monitoring, evaluation, and learning for water system management and sustainability

Emma Kelly BSPH Candidate

Focus: Sustainable water, sanitation and hygiene (WaSH) access in rural sub-Saharan Africa

Lisa Fleming MS Candidate

Focus: Improving local sanitation planning to reduce environmental health threats from fecal pollution

Kristen Lee BSPH Candidate

Focus: Rural water system sustainability in sub-Saharan Africa

David Holcomb PhD Candidate

Focus: Characterizing environmental exposure to human fecal contamination and its effect on child health in low-income neighborhoods of urban Mozambique.

Amy Guo BSPH Candidate

Focus: Water, sanitation, and hygiene in rural households, schools, and health care facilities; water microbiology

Lauren Joca MSPH and MCRP Candidate

Focus: WaSH in the healthcare setting, specifically how infrastructure quality and energy access affects service provision and patient outcomes.


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Sarah Long MS and MCRP Candidate

Focus: Successful governance models for successful service provision to low income communities

Meghan Miller PhD Candidate

Focus: Sustainability of rural solar-powered drinking water systems in sub-Saharan Africa

Hai-Ryung Sung PhD Candidate

Focus: Improving maternal and child health through better water, sanitation and hygiene in health care facilities in Cambodia.

Sarah Rhodes PhD Candidate

Focus: The evolution and dissemination of antibiotic-resistant Staphylococcus aureus in regions of dense industrial hog production in North Carolina.

Claire Tipton MS Candidate

Focus: Water/stormwater quality, environmental health, microbiology, drinking-water safety, GIS, water resource management

Karen Setty PhD Candidate

Focus: Best practices for integrating evidence into global water, sanitation and hygiene decision making.

Vidya Venkataramanan PhD Candidate

Focus: Understanding the nature and effectiveness of sanitation behavior change interventions, specifically Community-led Total Sanitation (CLTS).


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STUDENT AFFILIATE ALUMNI


Maura Allaire (PhD, 2015)

Dissertation: Adapting to extreme events: Household response to floods in urban areas (advisor: Whittington)

Andrew Armstrong (MSEE, 2011)

Thesis: Characterization of ionic copper for disinfection of stored drinking-water (advisor: Sobsey)

Ovik Banerjee (BSPH, 2012)

Honors Thesis: Evaluating country-level population vulnerabilities to water access due to climate related hazards using high spatial resolution methods (advisor: Bartram)

Rachel Baum (BSPH, 2012)

Honors thesis: Measuring the human right to water: Developing quantitative indicators through using existing data sets for the equity component of the human right to water. (advisor: Bartram)

Rachel Baum (MSPH, 2016)

Thesis: Bridges, barriers and potential benefits of implementing water safety plans in North Carolina. (advisor: Bartram)

Nikki Behnke (BA, 2016)

Annalise Blum (PhD, 2014)

Dissertation: Rural water source choice: A choice experiment from Meru, Kenya. (advisor: Whittington)

Kang Chang (MSEE, 2011)

Thesis: Water Safety Plan cost analysis: explanation building with case studies in the Western Pacific Region. (advisor: Bartram)

Elizabeth Christenson (MS, 2015 )

Thesis: Using remote sensing to calculate plant available nitrogen from industrial swine farms in North Carolina at the sprayfield and sub-watershed scales (advisor: Serre)

Jonny Crocker (PhD, 2016)

Dissertation: Evaluating the process, costs, and outcomes of engaging natural leaders and teachers in community-led total sanitation (advisor: Bartram)

Nicholas DeFelice (PhD, 2014 )

Dissertation: Drinking water risks to health 40 years after passage of the Safe Drinking Water Act: A county-by-county analysis in North Carolina (advisor: Gibson)

Jordan Deuink (BSPH, 2014)

Ben Foster (MS, 2013 )

Thesis: Managing water supply related financial risk in hydropower production with index-based financial instruments (advisor: Characklis)

Garrison Gordon (BSPH, 2015)

Sarah Hatcher (PhD, 2015)

Dissertation: Environmental presence of and potential occupational exposure to antibiotic-resistant Staphylococcus aureus in regions of high industrial hog operation density (advisor: Stewart)

Christian Jasper (MPH, 2011)

Thesis: The availability of water and sanitation facilities in schools contributing to health and educational outcomes: A systematic review. (advisor: Bartram)

A.J. Karon (MSPH, 2016)

Thesis: Evaluation of three different selective media for enumeration of Clostridium perfringens in untreated and treated wastewater (advisor: Sobsey)

Tori Klug (MS, 2016)

Thesis: Water system breakdown typologies and rehabilitation pathways in sub-Saharan Africa. (advisor: Bartram)

Caroline Kostyla (MS, 2014)

Thesis: Seasonality of drinking water contamination: A systematic literature review. (advisor: Bartram)

Tam Lee (BS, 2012)

Grant Ligon (MPH, 2012)

Thesis: Synthesizing waterborne disease outbreak data to assess water systems failure effects on health: A systematic review. (advisor: Bartram)

Camille Morgan (BSPH, 2015 )

Honors thesis: Status of water, sanitation, and hygiene access in schools in six African countries (advisor: Bowling)

Liz Morris (MS, 2011)

Thesis: Specifications and design criteria for a packaging sanitation solution for peri-urban areas in developing countries. (advisor: Bartram)

Osborn Kwena (MSPH, 2016)

Thesis: Impact of district-level managerial training of Kenyan government officials on the scale-up of Community-led Total Sanitation. (advisor: Bartram)

Nur Aisyah Nasution (MS, 2016)

Thesis: The dynamics of piped-water and sewer development in Jakarta, Indonesia 1945-2015: A case study using multilevel perspective (advisor: Whittington)

Edema Ojomo (MS, 2011)

Thesis: Climate change adaptation preparedness in developing countries: A study of 21 countries and knowledge, attitudes, and practices studies in Akwa Ibom and Lagos states in Nigeria. (advisor: Bartram)

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Edema Ojomo (PhD, 2016)

Dissertation: The influence of the enabling environment on drinking-water programs: Qualitative and quantitative analyses (advisor: Bartram)

Julian Oliver (MS, 2015)

Thesis: Predictors of E. coli contamination at rural water points in Kenya, Malawi, Mozambique, Uganda and Zambia (advisor: Gibson).

Kyle Onda (MSPH and MCRP, 2014)

Thesis: Intermittent versus continuous water supply: What benefits do households actually receive? Evidence from two cities in India. (advisors: Bartram and Tewari)

Alycia Overbo (MSPH, 2014)

Thesis: Health and household access to water and sanitation: A global analysis and systematic literature review. (advisor: Bartram)

Jennifer Platt (DrPH, 2012)

Thesis: Assessing health system functions and impact on health through water and sanitation (advisor: Greene)

Ryan Rowe (MPH, 2012)

Thesis: NC Latina BEAUTY salon project: Formative research, design, implementation, and evaluation of a salon-based health promotion pilot program in a Latino salon in the NC Triangle area (advisor: Bowling)

Stephanie Schwemlein (BSPH, 2014)

Honors Thesis: Systematic review and application of indicator selection methods for monitoring school water sanitation and hygiene. (advisor: Bartram)

Jennifer Gentry Shields (PhD, 2012)

Dissertation: Utilization of microbial source-tracking markers to inform targeted remediation and predict potential pathogens in the Cape Fear watershed (advisor: Stewart)

Hannah Spring (MSPH, 2012)

Thesis: Drinking water quality and health: stakeholder risk perception. (advisor: Bartram)

Kyle Villemain (BA, 2015)

Jackie Wallace (BS, 2015)

Ashley Rhoderick Williams (MSEE, 2013)

Thesis: Examining the relationship between distance and water quantity: a systematic review and multi-country field study. (advisor: Bartram)


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HONORARY DOCTORATE

Catarina de Albuquerque Honorary LL.D, 2015

Catarina de Albuquerque is a world-renowned international human rights lawyer and advocate. She earned her law degree from the University of Lisbon and completed the master’s program in international relations-international law branch at the Graduate Institute of International Studies in Geneva.

Throughout her career, Albuquerque has focused her efforts behind issues surrounding health and human rights worldwide. From 2004 to 2008

she presided over United Nations negotiations in regards to the Optional Protocol to the International Covenant on Economic, Social and Cultural Rights, resulting in an agreement allowing individuals to present complaints before the U.N. against their own governments for alleged violations of socio-economic rights.

Albuquerque also served as the first U.N. Special Rapporteur on the Right to Safe Drinking Water and Sanitation, holding the position until 2014. She currently serves as the vice chair of Sanitation and Water for All (SWA), a global partnership of more than 90 developing countries’ governments, donors, civil society organizations and others working toward universal access to safe water and adequate sanitation.

She has presented several times at the UNC Gillings School of Public Health, has participated in Carolina’s Water and Health conferences in 2010, 2011 and 2012. In 2013, she delivered UNC-Chapel Hill’s Health and Human Rights Lecture. Albuquerque has received many international and Portuguese national awards, including the Jean Pictet Prize in International Humanitarian Law, the Portuguese Parliament’s Human Rights Golden Medal, and the President of Portugal’s Condecoration with the Order of Merit.

AFFILIATED UNC FACULTY


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Margaret E. Bentley, PhD Carla Smith Chamblee Distinguished Professor of Global Nutrition Associate Dean of Global Health Associate Director, Institute for Global Health & Infectious Diseases

Peggy completed her MA and PhD degrees in Medical Anthropology from the University of Connecticut. She was on faculty in International Health at the Bloomberg School of Public Health, Johns Hopkins University and joined the University of North Carolina in 1998. Dr. Bentley’s research focuses on women and infant’s nutrition, infant and young child feeding, behavioral research on HIV and nutrition, and community-based interventions for nutrition and health. She has been involved in WaSH-related research, including integrated interventions for nutrition and hygiene. She has particular expertise in ethnographic, qualitative, and mixed-methods research methods and the application of these for program development and evaluation.

Jacqueline MacDonald Gibson, PhD Associate Professor, Department of Environmental Sciences and Engineering

Jackie has a multi-disciplinary background in mathematics, engineering, and science that she has applied to study risk assessment, policy, and communication for more than 25 years. Her research centers on predicting health impacts of alternative environmental policies, including policies related to water supply and sanitation. Her prior experience includes serving as associate director of the US National Research Council’s Water Science and Technology Board, where she led multiple studies to inform water-related policies of US federal agencies.

Benjamin Mason Meier, JD, LLM, PhD Associate Professor of Global Health Policy, Department of Public Policy Adjunct Associate Professor, Department of Health Policy and Management Zachary Taylor Smith Distinguished Professor of Public Policy

Ben works at the intersection of global health, international law, and public policy to analyze human rights in water and sanitation policy. With the United Nations declaring water and sanitation to be international human rights in 2010, he has studied the influence of this declaration on global water governance, national water policy, and water and sanitation outcomes. Facilitating accountability for human rights realization, his empirical research has framed indicators to monitor human rights implementation in the WaSH sector.


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Rachel Noble, PhD Mary and Watts Hill Jr. Distinguished Professor, Department of Environmental Sciences and Engineering and the Department of Marine Sciences Director, Institute for the Environment, Morehead City Field Site

Rachel has faculty appointments in the Institute of Marine Sciences, the Department of Marine Sciences, and Gillings Global School of Public Health. Her research interest is in rapid, highly specific molecular diagnostic tools for determining the types and quantities of viral and bacterial pathogens in water and food products. She actively collaborates with The Water Institute through her monitoring and assessment programs, student mentoring, conference organization, molecular methods training, and validation of novel methods for field-based applications.

Rohit Ramaswamy, PhD, MPH Faculty Director, Global Online MPH Faculty Director, Online Global Health Certificate Co-Director, Consortium for Implementation Science Associate Director Global Practice, Gillings Global Gateway® Clinical Associate Professor, Public Health Leadership Program

and Department of Maternal and Child Health

An engineer by training, Rohit’s area of work involves the development and application of Continuous Quality Improvement and Implementation Science methods to ensure that learning from Monitoring and Evaluation can result in enhancement to program activities in the field. Dr. Ramaswamy has been working with The Water Institute for 5 years to develop CQI capability in Global WaSH and to support the implementation of CQI programs in several African countries.

Jill Stewart, PhD Associate Professor, Department of Environmental Sciences and Engineering Deputy Director, UNC Center for Galapagos Studies Faculty Fellow, UNC Carolina Population Center

Jill is an environmental health microbiologist specializing in water quality. Her research focuses on development of tools to detect and track pathogens and antibiotic resistance elements in water, and to evaluate how human activities affect distributions of microbial contaminants on scales spanning households to watersheds. At The Water Institute, Dr. Stewart serves on the organizing committee for the annual UNC Water Microbiology Conference and she collaborates on projects to improve sanitation and water quality technology.

Mark D. Sobsey, PhD Kenan Distinguished Professor, Department of Environmental Sciences

and Engineering

Mark’s research, teaching and service encompass the detection, characterization, occurrence, environmental survival/transport/fate, treatment, human health effects characterization and risk assessment of viruses, bacteria and parasites of public health concern in water, wastewater, biosolids, soil, air and food to prevent and control water-, food- and excreta-borne disease. His recent research with The Water Institute focuses on innovations in household and community water treatment and new, improved and rapid microbial detection technologies for water and wastewater.


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EXTERNAL AFFILIATES

Water Institute Affiliates provide expertise and collaborate on projects and events, but are not normally salaried staff of The Water Institute. Our affiliates include faculty members at UNC and external affiliates who work in universities, non-governmental organizations, consultants or private industry.

Clarissa Brocklehurst Adjunct Faculty

Clarissa started her career working on the water and sanitation needs of indigenous communities in Canada and the US. Between 2007 and 2011, she was the Chief of UNICEF’s Water, Sanitation and Hygiene Section, overseeing UNICEF’s water and sanitation programming in 100 countries and playing a role in development of strategy and advocacy for the global water supply and sanitation sector. Clarissa is a member of the Board of Trustees of WaterAid UK and the Strategic Advisory Group of the WHO-UNICEF Joint Monitoring Program that tracks global progress on water and sanitation. She is a Senior Advisor to the global Sanitation and Water for All partnership, and works in a consulting capacity with several sector agencies.

Dr. Greg Allgood Adjunct Faculty

Greg is Vice President at World Vision, where he helps lead World Vision’s efforts to address the global clean drinking water crisis. Prior to joining World Vision, he worked for Procter & Gamble (P&G) for 27 years and founded P&G Children’s Safe Drinking Water Program. He has a PhD in Toxicology from North Carolina State University and a Master of Science in Public Health from the University of North Carolina – Chapel Hill, where he did research in water quality.

Dr. Eva Rehfuess Adjunct Faculty

Eva is a Senior Scientist at the Institute of Medical Informatics, Biometry and Epidemiology at Ludwig-Maximilians-University Munich. She also coordinates Cochrane Public Health Europe and the Collaboration for Evidence-Based Healthcare and Public Health in Africa. Nine years of working for the World Health Organization inspired her interest in evidence-based public health and her passion for global health. Her methodological research relates to the evaluation of complex interventions, including epidemiological study designs to assess intervention impacts, quantitative and mixed-method systematic reviews and innovative approaches for engaging with stakeholders.

Dr. John Tomaro Adjunct Faculty

John is the former Director of Health of the Aga Khan Foundation based in Geneva, Switzerland. He was the director of the Environmental Health Division of USAID’s Office of Health prior to joining the foundation, where he directed the division for 15 years. He serves as a consultant for a variety of international development organizations.


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Dr. Mark Elliot Affiliate

Mark is an Assistant Professor of Environmental Engineering at the University of Alabama. While a postdoc with The Water Institute, Mark conducted research on climate vulnerability and adaptation for water supply, water safety plans, household water treatment and small water systems. His current research at the University of Alabama includes global progress in drinking water and sanitation coverage, ultraviolet disinfection of drinking water, climate change vulnerability and adaptation of water and sanitation systems in low-lying Pacific islands, and determining the scope and impacts of onsite wastewater discharges in rural Alabama.

Felix Dodds Senior Affiliate

Felix is a writer, activist and futurist who has been active on the global water agenda for more than ten years. He was co-director of the 2014 UNC Nexus Conference on climate, energy, food and water and is an Associate Fellow at the Tellus Institute in Boston. He was the Executive Director of Stakeholder Forum for a Sustainable Future for twenty years (1993-2012). He has served on a number of advisory boards including the Bonn 2001 Water Conference, the Bonn 2011 Nexus Conference, and the Planet Under Pressure 2012 Conference. Dodds co-chaired the NGO Coalition at the UN from 1997 to 2001 and is credited with introducing the concept of stakeholder dialogues to the UN Commission on Sustainable Development in 1996.

Dr. Paul Sherlock Affiliate

Paul studied mechanical engineering with Rolls Royce aircraft in Bristol before joining Oxfam in 1975, where he travelled extensively, carrying out more than 200 emergency water, sanitation, and hygiene assignments. Since retiring from Oxfam, he has become a trustee and deputy chair of RedR (Registry of Engineers for Disaster Relief) UK and has carried out short term consultancies for ECHO, UNICEF, CRS and a number of universities. Paul has been a featured speaker at The Water Institute’s Water and Health Conference and is a trusted expert on water, sanitation, and hygiene in emergency settings.

Dr. Claudio Valsangiacomo Affiliate

Claudio is a biologist holding a PhD from the Swiss Federal Institute of Technology, Zurich. He is a Professor at the Swiss University of Applied Sciences of Southern Switzerland, leading the Centre for Development and Cooperation as well as the same Office on behalf of Swissuniversities, the joint institution for higher education at national level. He has been involved as health and water expert in development and humanitarian projects since 2001, with international consultancies on behalf of the Swiss Agency for Development and Cooperation (SDC), and various international organizations (WHO, UNICEF, USDA). He represents SDC in the Global Task Force for Cholera Control (WHO and UNICEF).

“From its inception six years ago, The Water Institute at UNC has provided

leadership and insightful, data-driven solutions that solve challenges and save

lives. It is our international hub for water science and policy — the acknowledged

leader in addressing the world’s most pressing water access and sanitation

issues. The Water Institute is one of our most powerful ambassadors sharing the

best of Carolina across the globe.”

– Carol Folt, Chancellor

The University of North Carolina at Chapel Hill

FINANCES


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Value of awards by year received

Annual expenditure by function

FINANCES


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Funding source distribution 2010-11 to 2015-16

Acknowledgements

Design: UNC Creative

Thanks to Tom Fuldner Photography, Barbara Tyroler, Jonny Crocker, Mike Fisher, Ryan Rowe, Ashley Williams, and others from The Water Institute for the photographs included in this publication. All icons are from the Noun Project, adapted from illustrations by Aha-Soft, Edward Boatman, Giannis Choulakis, Dinesh Pal Gautam, parkjisun, and nayeli zimmermann.

Special thanks to Jordan Dalton, who provided editorial oversight and design assistance.

is a vibrant, interdisciplinary center that unites faculty, students, and partners from North Carolina and from across high- and low-income nations worldwide. We create partnerships to better understand what works

and to develop effective, innovative solutions in improving water, sanitation, and hygiene for equitable

health and human development.

This review reflects on six years of insights and impacts on policy, programming, and practice at the

intersection of water, development, and health.

The

WATER INSTITUTE

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The WATER INSTITUTE · approach to water issues, including strengths in aquatic biology, drinking water chemistry and treatment, wastewater and sludge treatment, groundwater protection,