REPORT ON THE DESK RESEARCH OF HOUSEHOLD

WATER TREATMENT AND SAFE STORAGE, (HWTS)

PROMOTION AND DISTRIBUTION THROUGH WATER
UTILITIES IN ETHIOPIA
STUDY COMMISSIONED BY AQUA FOR ALL, REPORT
BY GASHAYE CHEKOL

Discussion with zonal water head and

utility manager of Debre Markos

Addis Ababa, Ethiopia, July 2016 h.foppen@aquaforall.org

 CONTENTS
Executive summary..................................................................................................................................... 4
1. Desk Research on HWTS distribution through utilities in Ethiopia ..................................................... 7
1.1 Background Information ................................................................................................................... 7
1.2. Why Water Quality Determinants are concerns and what is the standard for Ethiopia ................. 9
1.2.1 Major chemical concerns ......................................................................................................... 10
1.2.2 Turbidity, pH and chlorine residual .......................................................................................... 12
1.2.3 Microbiological Contaminants ................................................................................................. 12
1.2.4WHO Physic-Chemical and Microbial Parameters and risk ....................................................... 13
1.2.5 Minimum Water Quality Standard ........................................................................................... 14
1.3 Existing efforts to mitigate the problem ......................................................................................... 15
2. Get the Idea ....................................................................................................................................... 17
3. Overall Research Questions .............................................................................................................. 18
4. Methodology used for the Desk research ......................................................................................... 18
5. Scoping Field Visit results to the Utilities .......................................................................................... 19
5.1 Finote Selam Town: ......................................................................................................................... 19
5.2 Discussion results with Debre Markos Authorities ......................................................................... 23
5.3 Discussion results of the meeting at Adama ................................................................................... 25
5.4 Discussion result of Bishoftu Utility ................................................................................................ 28
5.5 Discussion result with Ambo Utility manager Ato Daba and the Mayor Ato Dhugasa ............. 29
6. response to the Overall Research Questions .................................................................................... 31
6.1 Does distribution of HWTS through utilities lead to increased acceptance of HWTS by the
communities and government structure? ............................................................................................ 31
6.1.1 Yes it will lead to increased acceptance of HWTS by the communities and government ....... 31
6.1.2 Perceived challenges for increased acceptance and recommended remedial measures ....... 33
6.2 Does distribution of HWTS through utilities lead to improved quality of water (safe water) at
point of use sustainably?....................................................................................................................... 34
6.2.1 Yes for this too because of the following reasons ................................................................... 34
6.2.2 Perceived challenges and recommended mitigation ............................................................... 35
6.3 Is engagement of utilities in HWTS distribution a better and viable option to reach vulnerable
target groups? ....................................................................................................................................... 35
 6.3.1 Yes it is a better and viable option for reaching vulnerable target groups better than through
the private sector .............................................................................................................................. 35
6.3.2 Perceived challenges for the vulnerable groups and mitigation option .................................. 35
6.4 Under which conditions does distribution of HWTS through utilities lead to hygienic behavior
(correct usage of the products)? ........................................................................................................... 36
6.4.1 The prevailing conditions for leading to hygienic behavior ..................................................... 36
6.4.2 Perceived challenges and mitigation measures ....................................................................... 36
7. INITIAL RESEARCH QUESTIONS: DESK STUDY.................................................................................... 37
7.1 Role of the utility ....................................................................................................................... 37
7.1.1 Cost/benefit calculations.......................................................................................................... 37
7.1.2 What will be the interest of the utility ..................................................................................... 37
7.1.3 What extra cost would the delivery of HWTS imply for a utility with, lets say 20,000 clients?
........................................................................................................................................................... 38
7.1.4 If these costs would be integrated in the water fee for existing utility clients, what would
this imply at household level............................................................................................................. 39
7.1.5 For un-served households (= households in or near the service area of the utility with no
connection to the grid or other safe source ..................................................................................... 40
7.1.6 Would distribution by utilities to un-served households lead to increased acceptance&
sustained use of HWTS amongst this target group? ......................................................................... 40
7.2 Role of the Ministry of Health ................................................................................................... 40
7.3 Role of Private Sector ............................................................................................................ 42
7.4 Affordability: payment in installments...................................................................................... 42
7.5 Affordability: use of a voucher systems .......................................................................................... 43
7.6 Payment of the Pilot .................................................................................................................. 44
8 Monitoring......................................................................................................................................... 45
8.1 Assumptions identified for the proposed pilot.46

9 Conclusion and recommendations.................................................................................................... 47

9.1 Conclusion ....................................................................................................................................... 47
9.2 Recommendation ............................................................................................................................ 47
10. References: .......................................................................................................................................... 49

3
EXECUTIVE SUMMARY
Globally, an estimated 663 million people lack access to improved drinking-water sources
(WHO/UNICEF, Progress on sanitation and drinking-water Update and MDG assessment:
2015- (http://www.who.int/water_sanitation_health/publications/jmp-2015-update/en/)),
and even where improved sources are available, the water supply is not necessarily safe. An
estimated 1.9 billion rely on either unimproved sources or improved sources that are fecally-
contaminated (WHO 2014-(http://www.who.int/water_sanitation_
health/gbd_poor_water/en/)).

Assurance of drinking water quality has been a pillar of primary prevention and continues to
be the foundation for the prevention and control of waterborne diseases. Water can and does
serve as a medium for disease transmission in countries of all continents. The most
predominant waterborne disease, diarrhea (whose main source is basically unsafe water), has
an estimated annual incidence of 4,600 million episodes and causes 2.2 million deaths every
year (Federal Ministry of Health National Water Quality Monitoring and Surveillance Strategy
document, May 2011 Ethiopia). In terms of global burden of disease, diarrhea ranks second
after respiratory infections. Children under five years of age are most affected: some 1.33
million die each year of diarrhea, representing 15% of overall mortality in that age group.

There are several variants of the feco-oral pathway of waterborne disease transmission. These
include contamination of drinking-water catchment areas (by human and animal feces) and
sources (through inadequate disposal of human or animal excreta, or domestic or industrial
waste).Transmission can also result from contamination in the distribution system (through
leaky pipes, obsolete infrastructure, and inadequate treatment and storage) and unhygienic
handling of stored household water apart from unprotected sources.

The potential health consequence of microbial contamination of water is such that its control
must always be of paramount importance and must never be compromised from WHO
guideline. According to WaterAid Ethiopia Water Quality Policy (July, 2014); the major
determinants of water quality which are of chemical concerns include; Fluoride, Nitrate, Iron,
Manganese, Total Dissolved Solid (TDS), Iodine, Arsenic. The other water quality concerns are
also turbidity, PH and Chlorine residual as well as Microbiological contaminants.

Therefore the issue of water quality both for the assumed safe sources; and the unsafe sources
remains a challenge and are the main reason for mortality and morbidity of human beings at
every age group. That is why prevention methods like boiling of water and/or use of House
Hold Water Treatment and Safe storage (HWTS) are of paramount importance and must do
precautionary measures.

Considering the Ethiopian case to coup up with such situations, according to the Growth and
Transformation Plan (GTP2) and the amended standard, at the end of 2015 the Ethiopian Rural
water supply coverage is 59%; the urban water supply coverage is 51% and the aggregate
national water supply coverage is 58%. The average functionality status of the country water
facilities is 15.5%. This indicates that out of 100 million plus population of Ethiopia now more

4
than 42 million people are left unserved with potable water supply. This data does not
consider the water quality challenge of the supplied water, which n not necessarily guarantee
safe water at point of use.

The current standard of water supply according to GTP2 document for Ethiopia among others
indicates minimum of 25 l/ca/d for rural set up to be availed in a radius of 1 km maximum
from home. Similarly for urban setup, it ranges from 40 l/ca/d to 100 l/ca/d to be availed
within a maximum radius (water fetching distance) of 250m. While this is the plan committed
to be achieved in 5 years (up to 2020), the biggest challenge for the utilities to realize this plan,
among others are, in adequate priority given for the sector against the gap; water resources
potential problems for many towns in the country that require huge investment; low capacity
of the utility staff to manage high tech water projects (both in implementation and
management) sustainably as well as expansion works for the fast growing urban population;
the inclusion of significant size of peri urban communities for every single town as a result of
the new urban development strategy, etc. The above problems are also relevant for the rural
setup inhabitants as well.

Given such multi-faceted problems, the existing effort of government to reach universal access
plan is to prioritize and more focus on new water project development and less attention is
given for sustenance and water quality standard of the existing schemes to ensure standard
water quality supply. The issue of water quality monitoring and surveillance and take prompt
action through availing innovative technologies (HWTS) that will be solutions for scattered
settlement pattern as well would have been one of the solutions through market based
business model with proper delivery channels. But in practice the private sector effort so far
towards this end is that they are confined to Addis Ababa without sufficient delivery channels
in regions and use only the NGOs that will buy them in bulk and dump to emergency areas
through free hand out system, etc.

Related to the mitigation measures, despite the marvelous effort to achieve universal access
to water supply access coverage nationally by government and its allies and also the private
sector suppliers are trying to introduce innovative practices like HWTS products the gap
between the demand and the supply is huge. To this effect, ideas were jointly developed on
private sector engagement, financing solutions and supply chains to achieve national targets
for HWTS but also looking for the engagement of other HWTS promotion and distributions
channels particularly the government structure with the leadership of the Ministry of Health.

The reason why such efforts are necessary is because; while there are significant efforts by
different private sectors on the promotion and distribution of HWTS, private sector alone is
not always effective in reaching the poor; Ethiopian Government needs to create support
mechanisms for immature or new businesses to make a substantial and effective contribution
towards achieving national standards for Safe Water at point of use and; after awareness on
health advantages of HWTS is raised, potential customers need to have a choice of
technologies and finance options to make their investment desirable, affordable and
sustainable.

5
Accordingly, to achieve national targets for HWTS, additional mechanisms to the existing
distribution channels will be required among which promotion and distribution of HWTS
through Water Utilities (drinking water companies) is studied for piloting. This report
therefore, covers the desk research result of house hold water treatment and safe storage
(HWTS) distribution through water utilities in Ethiopia.

While deciding on the desk study during the development of the Terms of Reference, taken
into account was the existence of the following unique opportunities of why distribution of
HWTS through utilities is ideal. These include; Utilities have a nation-wide presence; Utilities
are known as experts on drinking water; Utilities are committed to provide 100% Safe Water at
point of use; Utilities are service deliverers who operate financial management and can easily
engage in additional business activities; Utilities can play a role in promotion and sales of
HWTS to most vulnerable target groups (unserved population); Utilities can eventually also sell
HWTS to existing clients.

As the desk research methodology included both secondary data collection, scoping field visits
and face to face discussions, it was learnt that while there are attitude problems for some
utilities (one of five utilities) how to engage themselves in critiquing their service level and be
transparent; majority of the visited utilities (4 out of the 5) were so supportive of the added
value of the HWTS but also appreciated the distribution channel proposed. They were rather
committing to come half way and do their part with whatever way their support is needed.

A. The following are demerits of using utilities as promotion and distribution of HWTS
according to one utilitys opinion during the assessment:
1. The role of HWTS distribution should be through licensed private sectors who are tax
payer in line with the customs rules and regulations
2. From legal framework point of view, the utility believes that, for the utility to do this
assignment, it needs to receive formal letter from the responsible organ (MoH or
MOWIE). This utility rather recommended private sector safe water shop but the support
from utility to be rendered like training and maintenance services if needed.
3. In general that utility believes that as the utility claims availing safe water for the
inhabitants of the town, it is contradictory to promote about HWTS by utility (regardless
of their confidence on the existing supplied water quality and coverage level at point of
use).
B. From the merit side the following are boldly reflected by all the four utilities repeatedly:
1. They openly witnessed that both the access and water quality issues are challenged in
their own respective town water supply system. So they believe that distribution of HWTS
through utilities in addition to their effort of expanding the service delivery will lead to
increased acceptance of HWTS as well as the Utility it self
2. They also believe that as HWTS serves at point of use and any potential conveyance
contamination will be mitigated, distribution of HWTS through utilities will lead to
sustained use of safe water even when the capacity of the utility becomes less supportive
3. As government entity, the utilities also believe that engagement of utilities in HWTS
distribution can be a viable option to reach vulnerable target groups including charging

6
 less water tariff system. This will be the result of reaching the utility to each HH level and
understand the economic position of the poorest inhabitants better.
4. Apart from the fast growing town inhabitants, the peri urban newly joined inhabitants at
the moment are desperately demanding the water supply services while the capacity of
the utilities to reach all is by far lagging behind and this issue, to the extent, has become a
political agenda. Accordingly, it is in these settings that HWTS can serve as an important
ideal and timely measure to make drinking-water safer and will be a quick answer.
5. Considering the urban population growth rate in their respective towns and the level of
priority given for the water supply sector, they demand partners support including
capacity building in WASH services as enabler (for mayor, health office, education office,
municipality, finance offices, zonal water head and political leaders) in their own towns
with the engagement of such efforts. In this case they recommend the HWTS distribution
to be substantiated by capacity building and promotion as well as integration among
WASH actors while the Utility still takes the lead and all the responsibility.
Based on these findings, the study concludes that promotion of HWTS through utilities is
doable and better option whose merit is by far exceeds the demerit but also bring about
leverage as the rural communities can have access to HWTS with their own money and other
financing mechanisms like installment. Accordingly the study recommends to start the pilot on
phased approach by starting in two utilities first but if there is budget limitation in one utility
initially. The study also recommends that the supply chain and after sales service are
mandatory for sustained use of HWTS and sustain the service but also the utilities do not want
to miss the trust by the community as government body.

1. DESK RESEARCH ON HWTS DISTRIBUTION THROUGH

UTILITIES IN ETHIOPIA

1.1 Background Information

Globally, an estimated 663 million people lack access to improved drinking-water sources
(according to WHO/UNICEF, Progress on sanitation and drinking-water Update and MDG
assessment: 2015- (http://www.who.int/water_sanitation_health/publications/jmp-2015-
update/en/)), and even where improved sources are available, the water supply is not
necessarily safe. An estimated 1.9 billion rely on either unimproved sources or improved
sources that are fecally-contaminated (WHO 2014-
(http://www.who.int/water_sanitation_health/gbd_poor_water/en/)).

The quality of drinking-water is a powerful environmental determinant of health. Assurance of

drinking water quality has been a pillar of primary prevention and continues to be the
foundation for the prevention and control of waterborne diseases. Water can and does serve
as a medium for disease transmission in countries on all continents; all are affected, from the
poorest to the wealthiest. According to The Ethiopian Federal Ministry of Health National
Water Quality Monitoring and Surveillance Strategy paper, May 2011; the most predominant
waterborne disease, diarrhea, has an estimated annual incidence of 4,600 million episodes and
causes 2.2 million deaths every year. In terms of global burden of disease, diarrhea ranks

7
second after respiratory infections. Children under five years of age are most affected: some
1.33 million die each year of diarrhea, representing 15% of overall mortality in that age group.

There are several variants of the feco-oral pathway of waterborne disease transmission. These
include contamination of drinking-water catchment areas (by human and animal feces) and
sources (through inadequate disposal of human or animal excreta, or domestic or industrial
waste).Transmission can also result from contamination in the distribution system (through
leaky pipes, obsolete infrastructure, and inadequate treatment and storage) and unhygienic
handling of stored household water. Moreover, according to the same source, millions of
people are exposed to unsafe concentrations of chemical contaminants in their drinking-
water. This contamination may be linked to naturally-occurring inorganic chemicals such as
arsenic and fluoride, which cause cancer and tooth and/or skeletal damage, respectively.
Alternatively, it may be linked to a lack of proper management of urban and industrial
wastewater or agricultural runoff water, with potentially long-term exposure to pollutants,
resulting in a range of serious health implications.

It is in these settings that household water treatment (HWT) and safe storage can serve as an
important solution to make drinking-water safer. Health gains from HWT and safe storage can
only be achieved when treatment products are effective in removing pathogens from drinking-
water, and are used correctly and consistently. A variety of HWT products with performance
ranging from little to considerable pathogen removal are available elsewhere in the market.

Considering the Ethiopian case to coup up with such situations, according to the Growth and
Transformation Plan (GTP2) and the amended standard, at the end of 2015 the Ethiopian Rural
water supply coverage is 59%; the urban water supply coverage is 51% and the aggregate
national water supply coverage is 58%. The average functionality status of the country water
facilities is 15.5%. This indicates that out of 100 million plus population of Ethiopia now more
than 42 million people are left unserved with potable water supply. This data does not
consider the water quality challenge of the supplied water, which n not necessarily guarantee
safe water at point of use.

The current standard of water supply according to GTP2 document for Ethiopia among others
indicates minimum of 25 l/ca/d for rural set up to be availed in a radius of 1 km maximum
from home. Similarly for urban setup, it ranges from 40 l/ca/d to 100 l/ca/d to be availed
within a maximum radius (water fetching distance) of 250m. While this is the plan committed
to be achieved in 5 years (up to 2020), the biggest challenge for the utilities to realize this plan,
among others are, in adequate priority given for the sector against the gap; water resources
potential problems for many towns in the country that require huge investment; low capacity
of the utility staff to manage high tech water projects (both in implementation and
management) sustainably as well as expansion works for the fast growing urban population;
the inclusion of significant size of peri urban communities for every single town as a result of
the new urban development strategy, etc. The above problems are also relevant for the rural
setup inhabitants as well.

8
Given such multi-faceted problems, the existing effort of government to reach universal access
plan is to prioritize and more focus on new water project development and less attention is
given for sustenance and water quality standard of the existing schemes to ensure standard
water quality supply. The issue of water quality monitoring and surveillance and take prompt
action through availing innovative technologies (HWTS) that will be solutions for scattered
settlement pattern as well would have been one of the solutions through market based
business model with proper delivery channels. But in practice the private sector effort so far
towards this end is that they are confined to Addis Ababa without sufficient delivery channels
in regions and use the NGOs that will buy them in bulk and dump to emergency areas through
free hand out system, etc.

1.2. Why Water Quality Determinants are concerns and what is the standard
for Ethiopia

Pond water for human and animal

at Lemu woreda, SNNPR before
WAE/EECMY intervention 2014

There are different physic-chemical and bacteriological elements (determinants) for water
quality that have detrimental effect for health as a result of which standards are set. The
physic-chemical determinants can result naturally from rock types, human exercise like
effluent release/leakage from different sources, agricultural practices with runoff, industrial
pollutants and pathogenic contaminants. The level and concentration of these different
elements would have a positive or negative health impact and economic effect. Water quality
is therefore one of the most important service level factor to contribute for positive public
health benefit.

9
According to WaterAid Water quality policy (July, 2014), majority of which are referred from
World health Organization (WHO) standards, the following are determinants of water quality.
1.2.1 Major chemical concerns
The major chemical concerns include; Fluoride, Nitrate, Iron, Manganese, Total Dissolved Solid
(TDS), Iodine, Arsenic. Also the other water quality concerns are turbidity, PH and Chlorine
residual as well as Microbiological contaminants. The occurrence and level of prevalence of
the chemicals in Ethiopia and their effect on health are detailed below according to same
source.

Fluoride: is a major concern in Great Rift Valley Areas of Ethiopia with greater than 10mg/l;
and moderately high concentration are also available in ground waters from volcanic rocks in
the high lands. Long term use of high fluoride drinking water (greater than 200mg/l) is known
to cause both dental and skeletal fluorosis.

Nitrate: The UN 1989 report on Ethiopia indicated that nitrate concentrations are high in
ground water from several urban areas especially around Dire Dawa and Addis Ababa resulting
mainly from leaking effluent from septic tanks. Concentrations are likely to be high in urban
areas close to the ground water surface. High nitrate levels can develop in ground waters
(including for rural areas) as a result of: Runoff from agricultural land using nitrate fertilizers;
Contamination with urine and feces and Industrial pollution. Unprotected ground water
sources are particularly susceptible to contamination. High Nitrate concentration pose a
significant health risk to bottle-fed infants as nitrate inhibits the ability of the blood to convey
oxygen around the body, leading to a potentially fatal condition called blue-baby syndrome
or mathahaemoglobinaemia. Based on reference to the WHO guideline limits for these
contaminants are, Nitrtae-50mg/l (short term exposure), Nitrite 3mg/l-short term exposure,
0.2 mg/l long term exposure. WHO guideline value for combined nitrate plus nitrites; is the
sum of the ration of the concentration of each of its guideline value should not exceed 1.
Typical range in ground water is 0-100mg/l.

Iron: the ground water in most of the country is not likely to contain high concentrations, since
iron is expected in anaerobic or highly acidic ground water and which has not been reported in
the reported literature in Ethiopia. However, Iron may be present in drinking water as a result
of the use of iron coagulants or the corrosion of steel and cast iron pipes during water
distribution. Iron is also essential nutrient in human nutrition. Estimated of the minimum daily
requirement for iron depends on age, sex, physiological status and iron bioavailability and
ranges from about 10 to 50mg/day. Iron can be released from GI pipelines where the pH of the
water is very low and water is acidic. After longer period of time the pipes will get rusted and
the iron ion will be released from the pipe to the water and cause change in the color of the
water- become reddish and the test is also become metallic which in turn will result in to
abandon the water supply. Therefore, water with low pH - acidic needs decision whether the
water supply implementation is canceled, treatment option like addition of bicarbonate and
use of PVC pipes is used or other needs decision based on pH test of the water.

10
Manganese: Like Iron, the ground water in most of the country is not likely to contain high
concentrations of manganese, since it is expected in anaerobic or highly acidic groundwater,
which has not been reported in the available literature. Manganese is one of the most
abundant metals in the Earths crust, usually occurring with iron. It is used principally in the
manufacture of iron and steel alloys, as an oxidant for cleaning, bleaching and disinfection as
potassium permanganate and as an ingredient in various products. Manganese is an essential
element for humans and other animals and occurs naturally in many food sources. Manganese
is naturally occurring in many surface water and groundwater sources, particularly in
anaerobic or low oxidation conditions, and this is the most important source for drinking-
water. WHO limit for manganese is 0.4mg/l while typical range of manganese in ground water
is usually less than 1 g/l (up to around 1 mg).

Total dissolved solid (TDS): In the Eastern part of Ethiopia sodium and chloride are likely to be
dominant dissolved constituents, with total dissolved solids often in excess of 2000 mg/l. In
the Southern part of the Rift valley, sodium and bicarbonate are the dominant dissolved
constitutes. Ground waters from Ogaden region are noted to be dominated by sodium and
sulphate with total dissolved solids concentration in excess of 1500 mg/l. In ground waters
from the Wabe-Shebelle catchments of southern Ethiopia, dominant dissolved constituents
are reported to be sodium and chloride with total dissolved solids in excess of 300mg/l. Lowest
concentrations of dissolved solids (<500mg/l) are reported for ground waters from North
Central and Southeast highlands and on South side of the Rift valley.

Iodine: Iodine deficiency disorders are widely prevalent in several parts of Ethiopia. The
highest goiter prevalence is reported to be in Gammo Goffa and Benishangul Gumuz. The
iodine content of the drinking waters was not especially low, but that of local food crops were
reported to be generally low. Iodine- no recommended limit is given- Typical range in potable
ground water is less than 1 g/l to 70 g/l (extremes up to400g/l.

Arsenic: No data are known for arsenic in Ethiopia ground water. The geology of most of the
country suggest that concentrations in ground water are not likely to be high possible
exceptions occur where sulphide minerals occur in association with gold, platinum or copper
ores. Arsenic occurs naturally in certain rock types, soils, in the atmosphere and water bodies.
It can be released into ground water sources at elevated concentrations following weathering
reactions, biological activity, and volcanic emissions as well as through human activities such
as mining and the application of fertilizers containing arsenic compounds. It is endemic in
ground waters from certain areas and causes adverse human health effects after prolonged
exposure.

There is overwhelming evidence from epidemiological studies that consumption of elevated

levels of arsenic through drinking-water is causally related to the development of cancer
through several sites, particularly skin, bladder and lung. Arsenic is thus a high priority
chemical parameter that requires monitoring in water sources deemed to be at risk from
contamination.

11
Although Arsenic is not considered to cause a problem in groundwater of Ethiopia, it is
anticipated to occur in areas where sulphide minerals occur in association with gold, platinum
or copper ores likely restricted to areas of ancient crystalline rocks. However for the sake of
safety it is suggested that Arsenic tests to be done when sanitary survey indicates mining
around the water source. For the time being WAE have no projects around the known gold
mining areas. The Ethiopian Standard Drinking water-Specifications recommended maximum
permissible level for Arsenic is 0.01 mg/l. Arsenic is not high risk for the time being.
1.2.2 Turbidity, pH and chlorine residual
According to the same source, chlorine residual is where supplies are chlorinated, as they can
describe the microbial quality of drinking water. Therefore, these are recommended in water
quality monitoring program as they either directly influence microbial quality (in the case of
chlorine) or may influence disinfection efficiency and microbial survival (in the case of pH and
turbidity). There is no health-based guideline value for PH. Although pH usually has no direct
impact on consumers, it is one of the most important operational water quality parameter. If
water is acidic (low pH value) it causes corrosion of steel made pipe lines which intern causes
change in color and test of the water and become objectionable to use.

Water collection from pond

water for drinking in Konso
area, Ethiopia (WAE)

1.2.3 Microbiological Contaminants

The potential health consequence of microbial contamination is such that its control must
always be of paramount importance and must never be compromised from WHO guideline.
Fecally derived pathogens are the principal concerns of setting health based targets for
microbial safety. Water bodies usually consists of a wide verity of microorganisms, which
include pathogenic and non pathogenic. The non pathogenic microorganisms may lead to

12
other problems like test and odor, which may serve as indicator of safety and may influence
the water selection for consumption.

The principal concern for microbiological water quality is to the contamination by pathogenic
microorganism. Such pathogenic include bacteria, helminthes, protozoa and viruses. The
routing monitoring of pathogens is generally not undertaken for several reasons, such as due
to lack of analytical tools and where it is available is expensive and difficult to perform.
Individual pathogens cannot be guaranteed to be presenting in all untreated or unprotected
water depending on whether pathogen contaminated feces is present in the water or not. And
thus failure to observe a particular pathogen in water sample could not imply the absence of
other pathogens in water. But if resources permit assessing pathogens presence in source and
drinking water are useful tools for determining the public health risk from drinking water and
developing health based water quality targets.

Because of the above mentioned reasons and because most water-borne pathogens are
derived from feces indicator organisms, usually bacteria are particularly used to analyze the
microbiological quality of drinking water. The most commonly used are E. coli (type 1) or
thermo tolerant coli form which are exclusively derived from human and animal feces. The
identification of these E. coli strain from contaminated water is simple but time taking as it
requires a two step process presumptive and confirmatory testing methods. Thus many
drinking water quality monitoring programs use thermo tolerant coli form as a surrogate,
because results are quickly and cheaply obtained though it gives only a presumptive result.
1.2.4WHO Physic-Chemical and Microbial Parameters and risk
Table 1, WHO limits for physic-chemical parameters:
No Substance WHO limits Health risk
1. Fluoride 1.5mg/l Dental and skeletal Flurosis
2. Nitrate (NO3) 50mg/l Blue baby syndrome
3. Manganese (Mn) 0.4mg/l
4. Iron (Fe) 0.3mg/l No health based risk
5. Hardness 500mg/l Not health based
6. Ammonia (NH3) 1.5mg/l Not health based
7. Sodium (Na) 200mg/l Not health based
8. Sulphate 250mg/l
9. Hydrogen sulfide 0.05mg/l Not health based
10. Copper (Cu) 2.0mg/l Health based
11. Arsenic 0.01mg/l Health based
12. Lead (Pb) 0.01mg/l Health based
13. Chromium 0.05mg/l
14. Chloride (Cl) 200 300mg/l Test and corrosion are the main problems
15. Nitrite (NO2) 3mg/l
16. Alkalinity (CaCO3) 200mg/l
17. Potassium (K) 1.5mg/l
18. Colour (app) 15TCU
19. Turbidity 5 NTU
20. Conductivity 0.60 0.18s/cm

13
 21. pH 6.5 8.5 < 4 Acidic, 7 Neutral and > 7 Alkaline
22. Calcium (Ca) 75mg/l
23. Chlorine (Cl2) 5mg/l The residual free chlorine concentration after
30min should be 0.5mg/lit at pH < 8.0.

Table 2, Guideline values for verification of microbial quality (WHO guideline):

Organisms guideline value
All water directly intended for drinking
E. coli or thermo tolerant coli form bacteria Must not be detectable in any 100-ml sample
Treated water entering the distribution system Must not be detectable in any 100-ml sample
E. coli or thermo tolerant coli form bacteria
Treated water in the distribution system Must not be detectable in any 100-ml sample
E. coli or thermo tolerant coli form bacteria
Immediate investigative action must be taken if E. coli is detected. Although E. coli is the more
precise indicator of fecal pollution, the count of thermo tolerant coli form bacteria is an
acceptable alternative. If necessary, proper confirmatory tests must be carried out. Total coli
form bacteria are not acceptable indicators of the sanitary quality of water supplies,
particularly in tropical areas, where many bacteria of no sanitary significance occur in almost
all untreated supplies. It is recognized that in the great majority of rural water supplies,
especially in developing countries, fecal contamination is widespread. Especially under these
conditions, medium term targets for the progressive improvement of water supplies should be
set.

Table 3, Guideline value for disease risk classification using microbial density
Thermo tolerant coli form density per 100ml Disease Risk classification
<1 No risk
1-10 Low risk
11-100 High risk
>100 Very high risk

1.2.5 Minimum Water Quality Standard

The following are list of the national standard both for MoWIE and other stakeholders. The following
limits are selected to be tested for all new and rehabilitated water sources before distribution for
consumption. However some of the critical high risk parameters for which BGS has developed fact
sheet are subject to frequent check-up annually and as indicated by sanitary survey.

Table 4, Lists of the limits made by ESRDF (World Bank) and MoWIE:
No Tested Chemicals Standards/ Remarks
Permissible level
1 Colour (app) 15TCU TCU- true colour unit.
2 Turbidity 5 NTU Median turbidity 1 NTU, single sample 5NTU
3 Conductivity 0.60 0.18s/cm
4 pH 6.5 8.5 < 4 Acidic, 7 Neutral and >Alkaline
5 Ammonia (NH3) 1.5mg/l Impact on Odor and test
6 Sodium (Na) 200mg/l Taste problem
7 Potassium (K) 1.5mg/l

14
8 Total Hardness (CaCO3) 300mg/l
9 Calcium (Ca) 75mg/l
10 Magnesium (Mg) 50mg/l
11 Total Iron (Fe) 0.3mg/l
12 Manganese (Mn) 0.50mg/l
13 Fluoride (F) 3mg/l
14 Chloride (Cl) 200 300mg/l Test and corrosion are the main problems
15 Nitrite (NO2) 3mg/l
16 Nitrate (NO3) 50mg/l
17 Alkalinity (CaCO3) 200mg/l
18 Sulphate (SO4) 250mg/l Taste and corrosion
19 Hydrogen Sulphide (S) 0.05mg/l
20 Chlorine (Cl2) 5mg/l The residual free chlorine concentration after
30min should be 0.5mg/lit at pH < 8.0.
WaterAid Ethiopia limits of principal contaminants: With the priority of health risk and economic risk
which impacts health indirectly the following parameters under table-5 are considered as the minimum
WAE Water Quality Testing parameters for physic-chemical and bacteriological.

Table 5, WAE limits for principal contaminants to be adopted for frequent monitoring

No Tested Chemicals, Standards/ Remarks

physical & microbiological Permissible level
1 Fluoride 3mg/l Tooth and bone flourosis, rift valley common
problem
2 pH 6.5 8.5 < 4 Acidic, 7 Neutral and >Alkaline
3 Turbidity 5 NTU Median turbidity 1 NTU, single sample
5NTU
4 Total Iron (Fe) 0.3mg/l
5 Manganese (Mn) 0.50mg/l
6 Nitrate (NO3) 50mg/l
7 Nitrite (NO2) 3mg/l
8 Sodium (Na) 200mg/l Taste problem
9 Chloride (Cl-) 200-300mg/l Taste and corrosion problems
10 Sulphate (SO2-4) 250mg/l Taste and corrosion
11 Conductivity 0.60 0.18s/cm
12 Term tolerant E. coli 0/100ml High risk due to low sanitation and hygiene
coverage

1.3 Existing efforts to mitigate the problem

Despite major progress so far made to improve the health status of the population in the last
one and half decades, in Ethiopia the communicable diseases account for about 60-80% of the
health problems (according to the Federal Ministry of Health National Water Quality
Monitoring and Surveillance Strategy paper, May 2011). More than 90% of child mortality are
due to diarrhea, pneumonia, malaria, neonatal problems, malnutrition and HIV/AIDS, and
often a combination of these conditions. The existing burden of disease is preventable and a
considerable proportion is directly related to unsafe water. The average Ethiopian child usually

15
suffers five to twelve diarrhea episodes a year basically resulting from poor environmental
sanitation; and between 50, 000 to 112,000 under five children die annually due to the same
cause. To alleviate the above mentioned challenges, Ethiopia has prepared Universal Access
Plan for Water Supply, Hygiene and Sanitation Strategic Action Plan/linked to the Growth and
Transformation Plan (GTP1)1(2011-2015) and signed Memorandum of Understanding between
Ministry of Water and Energy and Education sectors where significant changes were
registered. Being encouraged by the result, but also realizing that more needs to be done, the
second GTP2 is also ratified to reach everyone everywhere for WASH facilities in the next five
years. While the issue of water supply access and coverage is what every actor in the sector is
straggling to achieve and the is an agreed gap, water quality agenda is the least prioritized and
National Water Quality Monitoring and Surveillance Strategy is the live gap in implementing
the Drinking Water Quality Standards in a coordinated efforts until the national the
development of The National Drinking Water Quality Monitoring and Surveillance Strategy
with the involvement of multitudes of partners in the arena. The development of this strategy
alone is not an end by itself a drinking water quality at point of use remains the challenge in
the country.

Therefore, parallel to such efforts; partners, bi-lateral and multi-lateral organizations and the
private sector at large are trying their best to support the realization of GTP 2 among which
innovative practices like Household Water Treatment and Safe Storage (HWTS) products are
designed and implemented which are utilized at point of use for safe water supply services. To
this effect, ideas were jointly developed on private sector engagement, financing solutions and
supply chains to achieve national targets for HWTS but also looking for the engagement of
other HWTS promotion and distributions channels particularly the government structure. It is
in these settings that household water treatment (HWT) and safe storage can serve as an
important solution to make drinking-water safer.

The reason why such efforts are necessary is because:

While there are unilateral efforts by different private sectors on HWTS, private sector
alone is not always effective in reaching the poor because of the reasons among others
include: lack of profitable supply chains; BOP is low margin market, problem with access to
credit and financing mechanisms, but also due to disruption of market by NGOs through
filter free hand out, etc. As a result, paradigm shift was needed to move from heavily
subsidized products for the poor to aspirational products that people desire
Ethiopian Government needs to create support mechanisms for immature or new
businesses to make a substantial and effective contribution towards achieving national
standards for Safe Water at point of use. The reason for this is that earlier days drinking
water projects were very much focused on source protection and the supply of water up to

1
National Growth and Transformation Plan, GTP I and GTP II
http://www.iea.org/media/pams/ethiopia/Ethiopia_GTP_2010to2915.pdf

16
 the delivery point. The quality of water at the point of use was up to the consumer and
HWTS dissemination was left to the private market only.
After awareness on health advantages of HWTS is raised through different mechanisms
like, strong and relevant health messages, health awareness campaigns integrated with
efforts to establish the private sector, availing quality HWTS products and encourage
saving for buying the product; potential customers need to have a choice of technologies
and finance options to make their investment desirable, affordable and sustainable.

Accordingly, to achieve national targets for HWTS, additional mechanisms to the existing
distribution channels will be required. The reasons among others are that access to safe water
for all cannot be left to the market alone. In addition, for scale up the effort, an integrated
approach is needed with public and private actors partnership. Some of the ideas among
others are:

1. Health Centers and pharmacies

2. Sanitation business centers
3. Water utilities (drinking water companies).

Whereas the other two distribution channels will be studied further and be piloted, this report
covers the desk research result of house hold water treatment and safe storage (HWTS)
distribution through urban water utilities in Ethiopia. The perceived benefits (unique
opportunities) regarding why promotion and distribution of HWTS are as follows.

When HWTS is recognized as part of mandate of the government (utilities) more

suppliers will emerge, prices fall, distribution channels will rise
Utilities have a nation-wide presence
Utilities are known as experts on drinking water
Utilities are committed to provide 100% Safe Water at point of use
Utilities are service deliverers who operate financial management and can easily
engage in additional business activities
Utilities can play a role in promotion and sales of HWTS to most vulnerable target
groups (unserved population)
They can eventually also sell HWTS to existing clients

2. GET THE IDEA

This desk research will investigate how HWTS products can be disseminated to households via
existing distribution channels and through innovative payment schemes in order to contribute
for government of Ethiopias effort to reach every one everywhere through Universal Access
Plan of safe water supply in line with the growth and transformation plan of the country. It is
expected that through HWTS business development it will bring proven model to scale. These
innovative payment schemes together with capacity building of decision makers; health
awareness and needs assessment campaigns are most probably the possible approaches to
connect with the targeted customers. The idea is to use the utilities as HWTS distribution

17
channel as they are already providing access to drinking water to a large part of the population
but also understanding that they cannot necessarily guarantee safe water at the point of use
to all inhabitants of their service area. Other distribution channels used to be the private
sector through marketing promotion to communities through NGOs, and direct sell to
communities and not necessarily creating enough awareness creation. It was necessary to
create awareness on how far the existing water supply system has both access and water
quality challenge. Before the pilot, in this desk research, we need to have some more insights
in the Ethiopian context and specifically, in the reality of Ethiopian utilities. Emphasis will also
be given to the real gap on the ground between the existing water supply access, quality gap
and how far this gap will be minimized by HWTS solutions to be distributed through utilities.
This desk study (research) made in line with the ToR will explain the information we need and
how and when we think this should be made available and with which resources. The research
was also been substantiated with field visit and conducting meetings with urban government
decision makers including the utility managers, the mayors, the municipality and the health
department of the towns. This visit to utilities is meant to explore interest of the mayor, the
utility office, the health office and the municipality of the sample visited towns to engage in
the pilot with utilities in the promotion and sales of HWTS as a service additional to the
delivery of drinking water. The field visit for the study to sample towns included Aqua for All
program manager Mrs. Hester Foppen from The Hague and ms.Yocaste from Holland who was
assisting in the note keeping and photography. The support role of Mrs. Hester Foppen and
guidance given right on the site during field visits, but also elaboration of the ToR more than
what it is in the ToR including guidance from distance was indispensable.

3. OVERALL RESEARCH QUESTIONS

The overall questions which the pilot has to answer are the following:
I. Does distribution of HWTS through utilities lead to increased acceptance of HWTS by
the communities and government structure?
II. Does distribution of HWTS through utilities lead to improved quality of water (safe
water) at point of use sustainably?
III. Is engagement of utilities in HWTS distribution a better and viable option to reach
vulnerable target groups?
IV. Under which conditions does distribution of HWTS through utilities lead to hygienic
behavior (correct usage of products)?

4. METHODOLOGY USED FOR THE DESK RESEARCH

The desk research methodology consists of:

Primary data collection by having face to face discussions with Integrated Urban WASH
team (Mayor, Utility manager, Health office head, municipality head and zonal water office
head); and phone conversation for the missing data needed for the study
In depth interview of the utility manager in order to check the access, coverage and water
quality status of the sample towns water supply situation; population and growth rate

18
 Check the future plans of the towns to mitigate the problem and their situation against
GTP2 standard;
Check the peri urban water supply situation in line with served and un served status,
Other secondary data like literature review,
The GTP2 standard towards per capita water supply plan of the survey town, the existing
population and the potential future population based on the population growth rate
(future demand)
Check the relevance and added values of HWTS for the pilot towns in question
Field visit to sample towns and visual observation as the situation allows and market
analysis for thinking

5. SCOPING FIELD VISIT RESULTS TO THE UTILITIES

As part of the research, field visit was convened by the consultant and Aqua for All Senior
program manager, Mrs. Hester Foppen and Yocaste to selected Utilities Finote Selam and
Debre Markos Towns from Amhara Region; Adama and Bishoftu Towns from Oromia region. In
addition, Ambo Town was also assessed from distance since the condition was not convenient
for the field trip by the time. Among these five Towns considered, three of them are WaterAid
intervention Town (Finote Selam; Bishoftu and Ambo). The findings of the scoping field visit as
summarized as follows:

5.1 Finote Selam Town:

The visit was made on the 6th July 2016 (Moslem Holiday) and the meeting participants were:

1. Ato Tibebu Amare - Mayor of Finote Selam Town;

2. Ato Liew Anmut Utility managerof Finote Selam Town;
3. Ato Mebratu Zemene Finote Selam Town health office head
4. Ato Kinde - Head of Zonal water office was contacted in phone but was in field work and
could not attend the meeting
5. The head of the municipality did not attend the meeting due to other assignment
6. Mrs. Hester Foppen Aqua for All program manager from The Hague
7. Gashaye Chekol Consultant for the Desk Research commissioned by Aqua for All

Finote Selam Town: we convened our discussion in Finote Selam on a non working day
(Moslem holiday - end of Ramadan). Even if we assumed that we may not get the officials
because of the holiday, it was rather an opportunity that they gave us half day fully for
discussion about HWTS products dissemination through utilities and opportunities and
perceived challenges related to it. This is because the town inhabitants are predominantly
Christian community.

19
 Discussion with the mayor and the utility manager, Finote Selam

Finote Selam Town is located at 380km North West of Addis Ababa on the way to Bahir Dar in
Amhara region. Finote Selam is currently the capital of West Gojjam Zone of Amhara region.
The town has assumed the role of Zonal center four years back (in 2011) which resulted in fast
growth that made the existing infrastructure not to suffice. While in the near future the towns
growth is very high and promising, the issue of access to safe water supply among others
remains a challenge. The total number of inhabitants at the moment (according to the
information from the utility manager) is 77,000 including the 10,000 inhabitants of peri urban.
To show case about the growth rate of Finote Selam the following are some examples. Some
2,500 houses are constructed with estimated population of 12,500 in one year (2015) alone.
The number of water supply customers from household water connection and public water
supply are currently 6,464 of which 1,040 of them are public water point users and 43 HHs of
the 5,424 HH water connections are newly supplied peri urban water user customers accessed
in 2015.

Regarding the existing water supply, the source of water supply for the town is predominantly
from two boreholes (88%) from the available discharge (yield) of 43.2 l/sec. There are also two
more springs with different discharge (yield) amount as shown in the table below.

Table 6: Existing Water sources of Finote Selam Town

S.N Water Yield(Q Existing condition Remarks

source )
1. Bore hole 1 33.5 77.54% of the town water supply but The problem may be minimized by
at Gewocha l/sec produces turbid water as a result of closing the quarry site and
site the water entering to the ground environmental activities like planting
water from nearby quarry site of indigenous trees as is already

20
 recently started by youths given for agreed by town and woreda
job creation. authorities
2. Borehole 2 4.5 l/sec Good water supply source Is good but the water is turbid since it
contributing 10.41% of the existing is mixed with existing turbid borehole
water supply yield water
3. Shenbeko 3.4 l/sec Good water supply source Was constructed many years back,
spring contributing 7.87% of the existing upper catchment not well protected,
water supply yield has a risk of decreasing in yield
4. Spring 2 1.8 Contribute 4.8% of the yield, good Similar case like above.
l/sec source
During our discussion with the Town WASH team members, we have asked the team about
the current water supply access and water quality for Finote Selam. The following are their
response:

The water supply in terms of access according to GTP2 standard currently is only 45% for the
urban dwellers. Because, the current water supply capacity is 29.8 lit/ ca/day with 8 hours
pumping while the standard of Finote Selam town is to avail 60 lit/ ca/day according to GTP2.
In order to meet the set GTP2 target the existing town needs to be upgraded to more than
double of the current water supply. This problem is in addition to a rampant turbidity and
water quality problem of the existing water supply. This analysis does not include the peri
urban inhabitants.

On the other hand the town is growing in an alarming rate where additional 5,000 new houses
will be constructed in the next 5 years (already the land is given) which means about 25,000
new inhabitants; a new industry zone is approved and materialized that demand huge water
supply; one faculty of Debre Markos University and other one faculty of Bahir Dar University
are to open 2017; there are one Teachers Training college, one private health college and
Technical and vocational training colleges with more than 5,000 students now (and are
increasing from time to time) opened but not included in the population data above; one new
referral hospital is under construction; a number of car wash centers coupled with gas stations
are opened, new big hotels are under construction.

This all informs not only the existing very big gap between the safe water supply and the
demand (still 55% of the existing town dwellers need is not met) but also will result in a huge
water crisis for the town. There are also old pipe systems that cannot guarantee safe water
even for the network accessed dwellers. Because of the 55% gap currently existing, the utility
tries to use shift system. The water supply is intermittent due to yield shortage and frequent
pipe failure. There are also some water points accessing water from the main lines before it is
treated at the reservoir with chlorine. The water quality test result has exposed the E. coli and
bacterial load and also the turbidity level which is outside the acceptable limit.

Even if the national average of urban population growth rate is 5.5%, because of the upgrading
of Finote Selam town to be zonal center; and Finote Selam is the most economically blessed
town due to the ideal agricultural resources; the growth rate is far exceeding 5.5%. Some
farmers around Finote Selam have income of 100,000 Birr to 200,000 Birr/year from sell of
pepper and coffee. This makes the town to be attractive and receive significant number of
youth and jobless migrants from rural as well as 12 other woreda towns in search of job and

21
making a leaving including entrepreneurs. The well-to-do farmers have also constructed
houses in Finote Selam for rent and for their children schooling as well as asset building.

On the other hand 5 new rural kebeles (wards) have become part of the Finote Selam town as
part of the medium term and long term development plan of the town with estimated current
population of 10,000 people. They are the peri-urban dwellers which are within 5km radius
from the center of Finote Selam Town waiting the utility to serve them safe water supply.
Some villages in these 5 kebeles currently possess only hand dug wells fitted with hand pump
and some rope pumps while more than half of them are using unprotected river and other
surface water including during the rainy season except the 943 people reached this year by the
utility with 3 water distribution fountains and the existing hand dug well users. The effort of
the utility is through expanding some pipe lines from the existing town water sources.

Among these 5 kebeles what is frustrating most is that more than 30 households of Mulisa and
Kes Amba villages are solely dependent of Lah River which crosses Finote Selam town and
carry a lot of liquid and solid waste apart from its all times turbidity. According to the utility
manager, these communities fetch water in the morning from the river and keep it until it
settles in the jar (jerry can) and use it after wards since they have no choice.

Based on all this first hand information during the meeting, the meeting participants were
asked about the value addition of HWTS to minimize this gap. They responded that they
believe HWTS that are used at point of use are very much relevant and acceptable. They
expressed their vested interest but also committed to deliver their role and support with
whatever is expected from them. Finally, as a reminder they recommended the following for
the pilot to be successful:

1. There should be enough awareness creation exercise by Aqua for All piloting team about
the product for decision makers to get political will and endorsement
2. Similar training should be given to Utility staff, health extension workers, and Town WASH
office focal staff of (utility, health, municipality, finance and economic development office
and mayor) by Aqua for All piloting team and by the utility staff.
3. Aqua for All piloting team must give awareness creation and how to use training about the
product with display of each product to the citizens forum and community representatives
with users manual.
4. They recommended that good planning and pre-intervention, enough capacity building
(awareness raising training) is the stepping stone for ensuring the success which could also
have the potential of reaching the rural 39 kebeles (wards).
5. Ensure after sales service and spare part supply chain (to commit during the awareness
training and materialize it during implementation)
6. To plan and develop system for supporting and showing how to use each of the HWTS
products for all community that buy the HWTS products or link with a maintenance organ
(private sector actors, suppliers, utility, etc). They also underlined ensuring the availability
of spare parts since they have faced similar examples in solar power appliances and
irrigation pumps that caused a lot of crisis because of the absence of after sales service and
replaceable spares

22
7. Supportive monitoring and supervision including ensuring that the promotion need to be
one of the check lists for the evaluation of the health extension works of the health office
in the long run.
8. Engage decision makers for supervision and feedback for future actions

One of the selling points about Finote Selam to accept the development initiative in addition
to the felt need was because; it is the intervention area of WaterAid as part of the 20 towns
WASH capacity building program. So the fact that the consultant was WaterAid colleague and
the utility is well capacitated was one reason to openly appreciate the problem, confess and
openly disclosed the realities of safe water challenge and as a result shown maximum interest.
The assessment result has also the potential of triggering further actions by government and
development actors as the distribution of HWTS alone may not solve all problems given all the
existing and perceived gaps mentioned above.

Accordingly the consultant has recommended Finote Selam to be the first priority town to
pilot HWTS distribution through utility delivery channel.

5.2 Discussion results with Debre Markos Authorities

The meeting was held in the utility managers office coupled with demonstration of Tulip Addis
filter raw water filtration with the following participants:

1. Ato Adisu Ayele Zonal water, mineral and irrigation head and board chair of Debre Markos
Utility
2. Ato Melisachew Demelash Utility manager of Debre Markos Town
3. W/ro Tsige Dires zonal water quality expert
4. Mrs.Bahir Dar Hester Foppen program manager for Aqua for All from The Hague
5. Ms.Yocaste from Holland, keeping notes and photography
6. Gashaye Chekol consultant for Aqua for All

Display sample
HWTS (Tulip Addis
water filer) at
Debre Markos
.

23
According to the zonal head and the utility manager joint explanations the context of Debre
Markos is as follows:

Debre Markos is located at 295k from Addis Ababa towards North Western direction on the
main road to Bahir Dar. Debre Markos is the zonal Town of east Gojjam Zone of Amhara region
and one of the oldest towns in the region. Currently in Debre Markos there are 107,433
inhabitants including the peri-urban dwellers (according to the data in the utility office). So
Debre Markos Town is Grade 4. That is why the per capita water demand for Debre Markos
inhabitants is 80 lit/cap /day.

Table 7: The per capita water demand for Towns based on existing population (GTP2,):

S.N. Number of inhabitants Grade Per capita water demand Remarks

1. Less than 20,000 1 40 A town in Ethiopia is defined as
residential area with 2000 people
2. 20,000-50,000 2 50
3. 50,000-100,000 3 60
4. 100,000-1,000,000 4 80
5. More than 1,000,000 5 100 The only Grade 1 city in Ethiopia
currently is Addis Ababa
The source of water is exclusively from ground water. The aggregate amount of water supply
yield for the town is 120.5 lit/sec generated from 13 bore holes. From this, 95.5 lit/sec of
discharge (yield) is generated from the 5 newly constructed bore holes while the rest 25 lit/sec
yield is generated from the old 8 bore holes. When the water demand analysis is calculated,
the ideal available water supply with 8 hrs. of pumping from all the boreholes is 32.4 lit/ca/day
that can be available (disregarding discontinuity because of electricity). But according to the
GTP2 standard Debre Markos town is rated as 80 lit/ca/day water supply. So the existing water
supply has a deficit of 47.6 lit/ ca/day. (One person from his/her demand of 80 lit/day gets
only 32.4 lit/day).

The problem of Debre Markos is not only this gap. According to the information from the
meeting participants, the existing 5 bore holes and two buster stations transformer potential is
only 380 Volt while the required electricity capacity to run the 5 stations is 400 Volt. So the
utility is compelled to run the pumps only during the night time and with reduced capacity. As
result the current 107,433 inhabitants get water every 3 days and sometimes once in a week
with shift.

For the peri urban dwellers the situation is even worst. While there are 7 kebeles (wards) that
joined Debre Markos with a population of 7,641 inhabitants, they only have 14 HDWs, 2
springs developed on spot and 10 water distribution points expanded from the Debre Markos
urban water supply grid system (which supplies water only during the night time). As the
settlement pattern of rural communities is also so scattered the number of unserved
inhabitants are more than half that justify the need for HWTS.

During the discussion the issue of water quality was raised and they mentioned that there is a
permanent weekly addition of chlorine for the water supply and check water quality test by

24
their own water quality experts once in a month. The zonal water office water quality expert
also randomly check the water quality status and she feels that it is ok except the issue of
intermittent water supply old pipe lines that are exposed for contamination. She also
confessed that it is very difficult to speak about access coverage with such electricity supply
situation.

In general there is a challenge in the access which is below the set per capita water supply per
day and most importantly intermittent water supply system that demands huge intervention.
Until the demand and supply is compatible (met) and also beyond, there is a huge demand for
HWTS for the 7,000 inhabitants of the peri urban which literally do not get water and highly
relied on un safe river waters in the area which also travel long distance to get unsafe water.

The other interest expressed by the zonal water head was about the need for considering 25
other utilities in East Gojjam zone under his management for the distribution of HWTS based
on their situation. He mentioned that, except few towns who have better water access and
water quality, almost all the towns with their own utility offices have a lot of challenge and
need HWTS.

Accordingly we have submitted sample one Tulip water filter to be demonstrated during the
upcoming all utilities annual meeting. Ato Adissu requested one A4A representative to join the
meeting and promote the idea, if possible. The date of the meeting will be announced soon
which will be in less than a month time. He has also promised to register the demand of the 25
towns after it is being assessed during the upcoming meeting. The meeting participants which
comprise the East Gojjam Zonal head of Water, irrigation and Energy who is also Board Chair
of the Utility; and the Utility manager of the Debre Markos Town have shown their vested
interest for the value addition of HWTS in supporting the universal access plan targets. Debre
Markos is the capital of East Gojjam Zone and one of the oldest towns in the country with 25
utilities under it and with a town standard of 80 lit/ cap/day for every inhabitant, according to
GTP2. Debre Markos is supported by WHO for piloting water safety plan but not WaterAid
supported town.

5.3 Discussion results of the meeting at Adama

Discussion participants were:

1. Ato Tadele Shigutie deputy manager of Adama Utility

2. Kokebe from Adama municipality sanitation expert
3. Mrs Hester Foppen program manager of Aqua for All from The Hague
4. Yacoste from Holland, keeping notes and photography
5. Gashaye Chekol consultant of the Desk research for Aqua for All

The purpose of the discussion and why Aqua for All paid this visit was briefed by the team. In
line with the purpose, the Adama safe water supply context was asked to Ato Tadele to
explain.

25
 Discussion with the deputy
utility manager at Adama

Ato Tadele explained as follows: Adama has estimated population of 500,000 inhabitants
located in the rift valley at a distance of 100km towards the Eastern direction from Addis
Ababa. The Town is a fast growing and industrial city that demand a lot of water. Adama is in
the rift valley where a number of bore holes have more than 50 degree Celsius hot water. For
such hot waters, the utility can not avail pumps that pump enough water as per the yield of
the wells. The town is also suffering from flood, water quality problem including fluoride, other
chemicals, turbidity as majority of the water source are from Koka dam surface water.

To mitigate the problem the town has ratified three term plans including short term, medium
term and long term plans.

1. The short term plans was to drill 2 of the 4 bore holes where 2 bore holes are 98%
completed and will be completed mid 2016. This in addition to the existing Koka-Adama
old water supply system which will significantly improve the access to water supply at least
for Adama Town inhabitants.
2. The medium term plan is completion of the remaining 2 boreholes possibly towards the
end of 2016. With this intervention the utility believes that the existing shift system will be
stopped and expect 12 hours water supply system will be realized. The current water
supply system is supplying water once in 4 days and for some villages every three days.
3. The long term plan is implementation of Koka - Adama Dam surface water expansion
project which costs 1.5 Billion Birr where the fund is secured from Water fund and the
region budget. This is planned to be completed up to 2020. It is now under the preparation
for bidding and contract awarding stage which is expected to start in 2016.

26
As the existing water sources are still from Koka dam surface water, before the start of the
current rainfall, the dam was almost dried due to the drought; but is now recovering following
the good rain fall. The water resources potential of the Adama area (rift valley Zone) is unique
around Adama where the ground water is available below 150m depth; majorities of the bore
holes water can be hot water, is fluoride prone, the area is so hot that evaporation of surface
water reserved in Koka dam is significant; fresh water is almost non-existent; water quality and
turbidity are generally common features that challenge the water supply system; flood hazard
during rainy season is serious while the design per capita water demand is 80 lit/cap/day. But
in actual practice, people now get water once in 3-4 days. Because of the water quality
problem, chlorine and calcium phosphate are frequently added to mitigate the chemical and
bacteriological water quality problem. Where the central town inhabitants are in such
challenging situation additional 4 kebeles have now joined Adama Town with even sever water
shortage and worst demand than the town. The number of these peri-urban dwellers is
estimated to be more than32416 currently. Also Adama is growing more than other cities
because of the industrialization, job opportunities and the fact that it is workshop city. The
addition of chemical (chlorine and others) for the drinking water supply for treatment,
according to Ato Tadele, is very frequent (daily) where significant improvement is registered in
quality. This is because the water entering Koka is fresh flood from the upper catchment and
plowed land; and the water in Koka reservoir was almost empty.

On top of this, because of the flooding during the current rainy season, 3 villages in the town
are resettled in other localities as emergency action with estimated population of 6000 people.
This has made the water supply system even more complicated and expensive. In addition,
there is no system of availing water for free for the poor and installment is not used as a
system except in some areas the utility is taking risk and install piped water for repayment in 2
to 3 years.

One of the interesting innovative works started in Adama is modern billing system by mobile
phone, leakage detection machine availability with the support of Netherlands Government
and free line for public opinion by phone number 3089 where more than 50,000 customers are
now benefitting. The support of VEI (an international NGO that support such innovative
technologies) is well appreciated.

Actually the safe water supply problem of the town is well recognized by government at all
levels where the utility has 5 satellite offices (a unique structure), apart from the main utility
office and is equipped with one mini-bus for water quality monitoring follow up and other
works and the board chair of Adama is Ato Alemayehu Tegenu who was the former minister of
Water Mines and Energy and currently office head of the prime minister unlike other cities
where the board chair was supposed to be the mayor of Adama.

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5.4 Discussion result of Bishoftu Utility
Discussion participants:

The discussion was held with the Utility manager of Bishoftu Ato Hailu, while the study
team is Mrs. Hester Fopper, Yocaste and Gashaye Chekol (the consultant). Ato Hailu
explained the Bishoftu situation (context) as follows:

Bishoftu has more than 250,000 inhabitants. The sole water supply source of Bishoftu is
exclusively from ground water that is obtained from 18 bore holes. The capacity of the
boreholes yield is 230 lit/sec in aggregate. The capacity of the boreholes water production is
19000 M3/day. But the water reached per day after leakage and down time is 13,000
M3/day (sold every day). The water demand per day for the inhabitants is calculated to be
20,000 M3/day according to GTP2 standard (80lit/ capita/day. Out of these boreholes, one
of the boreholes has 50 lit/sec discharge but is 500C hot water. But the available pump for
the utility that can pump the 500C hot water is with a capacity of 13.6 lit/sec. Ato Hailu
mentioned that what is available in the market for hot water pump locally is up to 35 0C and
is pumping only under capacity (13.6 lit/sec).

Bishoftu is one of the fast growing cities and has 28,000 customers now and 3000 to 3500
new customers are increasing every year. Except some industries that use their own bore
holes all the industries are dependent on the water availed by the utility mentioned above.

Ato Hailu, when asked about the value addition of HWTS, suggested the following. Yes the
value addition has no question for the inhabitants where there is old pipe system, there
are there are peri-urban inhabitants. However, Ato Hailu adds:

The role of HWTS distribution should be through licensed private sectors who are tax
payer in line with the customs rules and regulations
There should be standardization certification for the HWTS products from the
Standardization Agency or MoWIE or MoH
If the utility is to enter in distribution of HWTS needs to receive formal letter from the
Oromia water bureau or MoWIE to play this role
He recommends also that why not safe water shop be opened by private sectors
licensed and the utility support the quality assurance, training and other ways
necessary to ensure proper use
He also believes that the market is abundant particularly for rural dwellers that can
purchase from this safe water shop located in Bishoftu and the promotion can be
supported by the rural government structure
He also believes that installment is still necessary to reach every one (inclusive)
Only sample HWTS can be kept in utility office and not more than that role unless
formal letter is written from whom it may concern
He believes that the pilot should focus for rural areas preferably; and if necessary the
utility may help distributing to rural if the letter is received.

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 In general he believes that as the utility claims availing safe water for the inhabitants of
the town, it is contradictory to promote about HWTS by utility (regardless of his
confidence on the existing supplied water quality at point of use).
Bishoftu has pump problem for a number of BHs (frequently burning), has 30%-40%
leakage, there is water quality problem and even not known as it is tested quarterly,
turbidity problem, usually they do not use the reservoir as majority of the inhabitants
get water with direct pumping. Yet, the fact that the utility manager was rather not
enthusiastic about mitigation measures by trying every possible means to solve the
community problem is surprising. When interviewed he was not even interested to
mention the above problems where WaterAid has identified long ago and is relentlessly
working for the mitigation measures. May be Ato Hailu is new (nine months now since
he become utility manager). WaterAid has now availed modern water quality test kit,
leakage detection equipments as well as doing a number of capacity building
interventions and is expected water quality be tested at least once in a month as per
the agreement made.

5.5 Discussion result with Ambo Utility manager Ato Daba and the Mayor
Ato Dhugasa
The discussion with Ambo Utility was made from distance and was only with the utility
manager Ato Daba Ararsa and the Town mayor Ato Dhugasa Oluma by the consultant Gashaye
Chekkol

Even if Ambo was planned to be visited by the research team the visit could not take place due
to security reasons as the planned field visit overlapped with the long overdue final national
exam of grade 12. By the time internet and other communications were down and there was
indications that we need not pay a visit related to security alarm. So the assessment was done
from remote by having frequent phone discussion with the manager of Ambo Utility Ato Daba
and Ato Dhagasa by the consultant. The study by the consultant was not based only on the
phone conversation and the vested interest shown by the utility manager and the mayor. The
fact that Ambo is one of the 20 WaterAid urban WASH capacity building program and the
knowledge of the consultant about this town as WaterAid colleague related to the ToR of the
Desk research was one other factor that contributes a lot for the study result and the
recommendation there off. Accordingly, Ambo was found to be one of the neediest towns for
HWTS due to the following reasons next to Finote Selam.

According to the two key informants (the mayor and the utility manager), the total population
of Ambo Town is currently 96,000 (for the town alone) but when the peri urban dwellers of 3
kebeles are included the total population is estimated to be 107,000 inhabitants. The water
supply source is surface water that flows from river that starts from a lake. The river water is
diverted by micro-dam and there is a sophisticated water treatment plant that has silt
settlement and chlorination unit. The consultant has visited this water supply system in earlier
days. So from access for water supply point of view, Ambo Town is probably one of the few
cities in Ethiopia that has supplied water 100% not only for today but also in the coming 20
years to come (the projected period). There are 33 water distribution points that are

29
constructed to serve 30 HHs/water point for each on the average with 104 km pressure and
main pipe line network. So all the 20,000 Ambo University community, all the urban dwellers
and part of the 3 rural communities are served from access point of view.

The standard per capita water demand according to GTP2 for Ambo Town is 60 lit/capita/day.
But when the actual utilization is calculated 5,000m3 to 6,000M3 water is consumed (sold)
while the water supply production has the capacity of 10,000 M3 per day.

What are then the challenges on Ambo Town related to potable water supply?

Upper catchment of the water source is fully plowed land that generate a lot of silt and
chemical fertilizers applied to the crop field
The environmental protection is almost none
There are significant number of dwellers on this upper catchment who also exercise open
defecation, livestock rearing and other human interventions that can potentially be
washed and enter the river, before and after the diversion site
There is a challenge of who to manage the upper stream of this source, main pipe line and
all the way up to the town since the catchment area is not the town part
The water is turbid, highly dependent on the prevailing rainfall and the flood entering to
the system
The waterfall with debris has filled the pipe line last year and 40 m was closed and re-
opened that closed even the turbid water.
This year too, the flood with silt and debris has closed the pipe line and there is no water
supply at the moment. What is surprising currently is that from the assigned workers to
open the line, one person is taken by flood and died where even the body is not yet found.
And there is no water supply at the moment at Ambo when this report was developed.

Accordingly when the mayor and the utility manager were asked about the value addition of
HWTS solutions, they responded that this is fully supported and timely solution by the
leadership. The mayor has further said that he has reported the case to the federal and
regional level and he believes there will not be overnight solution that strengths the need for
HWTS solutions for Ambo Town, the peri urban area and can also be used for the rural
woredas and kebeles being distributed through the Ambo Utility. They said they can half way
come and support the effort at any area their role is needed.

Accordingly, the consultant recommended that Ambo is the second needy utility where the
pilot needs to be started by Aqua for All as access alone is not an end for safe water supply at
point of use. The access available is also good for supplying raw water and be filtered (treated)
for use in the town.

The findings of the desk study (research) substantiated by the scoping field visit are
summarized by responding to the overall research questions 1-4 as explained below including
the perceived challenges as well as recommended remedial measures.

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 6. RESPONSE TO THE OVERALL RESEARCH QUESTIONS
6.1 Does distribution of HWTS through utilities lead to increased acceptance
of HWTS by the communities and government structure?
6.1.1 Yes it will lead to increased acceptance of HWTS by the communities and government
The target communities are both with household connection from the town water supply
system as well as the peri urban ones who are not served with access to water. As clearly
learnt from the Finote Selam utility needs and willingness assessment, before embarking on
the distribution of the HWTS products (piloting) there needs to do an awareness creation
and capacity building exercise to the decision makers (mayor, health office, municipality,
utility staff and political leaders) to ensure buy-in and achieve political will. The training
should be substantiated by the existing facts and figures related to the Growth and
Transformation Plan (GTP1) achievement level of the area; current water supply coverage
against GTP2 targets of the town; the town population growth rate (5.5%) against the
town effort and achievement status to reach the unserved community; the town water
quality status, possibility of meeting the GTP2 target in 5 years, etc. So as long as the
required pre intervention work is done, distribution of HWTS through utilities will lead to
increased acceptance of HWTS. The role of utilities will be initially until market lead value
chain by private sectors is strengthened. This is expected to happen after the community
realize the value addition of the HWTS products through testing and using them enough.
Similar exercise will also need to take place to the Integrated Urban WASH Forum (IUWF)
and community structure by supporting the exercise with water quality test result
conducted within, top ten diseases data from health institutions, show sample drinking
water before and after filtration; and visual show and drink the filtered water in front of
the people, but also explain the after sales service availability as well as spare parts supply
chain presence. This will also lead to increased acceptance of the utility delivery channel.
As repeatedly remarked by the Finote Selam Utility head the experience of solar powered
technologies and irrigation water pumps failure linked to absence of after sales service and
spare parts; sufficient preparation needs to be made to ensure after sales service and
supply chain for spares. This is not a choice but is must and ensures increased acceptance
of the HWTS
Ensure that every house hold (HH) has the right knowhow to use and manage the chosen
HWTS (training /demonstration and manual). This builds confidence for those using it but
also others to demand for it.
Avail all HWTS types as options to the pilot utility and engage the private sector on
appropriate timing with harmonized approach
As the users are urban dwellers who do things with reason, once they are convinced they
will sustainably use the HWTS but are also negatively promoting if not well prepared and
not well understood for use by all
Once the willingness is ensured, the affordability may not be an issue for most of the urban
dwellers. For the rest urban poor, other options like installment will be employed. This

31
 inclusiveness creates acceptance and appreciation for Aqua for All and the pilot utility for
their image and reputation as specialist in safe water
The peri urban are currently the most marginalized and vulnerable group that depend on
unsafe water and exposed for water borne diseases. So they are potential targets since
they are already detached from the rural (the urban has engulfed them) but also not
beneficiary from the urban water supply network (system) including all forms of social
services available in the urban. So, as the chance of reaching these parts of communities
requires long time by the piped or other water supply network, the HWTS option will be
most welcomed and accepted here more than the central urban.
Since the urban dwellers are concerned about water quality and turbidity more than the
rural, if there is indication of water quality gap on the existing water supply system
including turbidity, they will accept the technology right away, promote for others but also
use it sustainably
Users know utilities as sole suppliers of potable water and believe that safe water supply is
exclusively the role of utilities. So the acceptance for the products is better than any
channel when distributed through utilities.
Since reaching about 1000 current towns/cities in Ethiopia and the upcoming about 17,000
small towns (according to ministry of urban Housing and construction) is less likely to be
achieved in potable water supply in the short run, the distribution of HWTS options that
serve at point of use is ideal solution which the utilities also do consider it as critical
support to deliver their role.
More than any time some towns in Ethiopia including Addis Ababa are affected by Acute
Watery Diarrhea which has created emergency situation in the country that has created
huge demand for HWTS but also once experienced by users HWTS acceptance will
continue and sustain.
The utilities can be delivery channels for the rural set up (39 rural kebeles (Wards) as well
since rural (woreda) water offices do not have mandate to act as distribution channels with
by generate income as they are not established in business model unlike utilities. They can
do only as long as they do it as their day to day job being assigned by federal and regional
water ministries and bureaus without any form of income generation. At the moment, for
Ministry of water and water bureaus to own the HWTS distribution as one best means of
meeting universal access plan and order their respective woredas to distribute HWTS
without commission is unlikely. It requires a lot of influencing work after successfully
piloting and scale up. So extending the role of utilities for rural set up too, can be thought
of at least in strong utilities and very needy rural areas for now.
The HWTS quality (like ease and convenience of operation; and the water quality
improvement level) matters for the level of acceptance. The product must sell itself.
Availability of manual with local language, the promotion of the HWTS, the
scope/methodology of the promotion based on the nature of the audience is critical for
increased acceptance apart from the distribution channel to make it business model and
market led in the long run.

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6.1.2 Perceived challenges for increased acceptance and recommended remedial measures
The way the awareness creation will be done at all levels (for decision makers to end users)
matters for the success and failure of the mission. Also the leadership attitude and
previous relationship with piloting team of Aqua for All should be taken in to account or at
least need enough pre-work. So it is advisable to start the pilot on such ideal utilities and
learn more for scale.
One product (HWTS) may be better than the other which can confuse and take time for
users to understand and decide which product to choose from the other as one HH may
not possess all HWTS options. Also the merits and demerits of each product should be
clearly informed by Aqua for All and the utility since private dealers tend to convince users
to choose products they import than others based on the capacity of their promoters.
There is a need to have harmonized approach of intervention (including avoiding
duplication of effort and need to provide consistent information and data) between the
utility/Aqua for All and private sectors (if they are doing parallel effort)
We can find some users who are well-to-do and be interested for other modern and
expensive types of HWTS instead of the low cost ones we are thinking of which further
minimizes the target users in urban set up.
If the water quality is not an issue in the town the target group will be limited to the peri-
urban and extended families of the urban community. Still every target group challenge
the product available if the product cannot sell itself.
The role of Aqua for All should be clear and be understood by stakeholders (as enabler
INGO and partner of government to reach the unreached by an innovative way and also
that Aqua for All believes the engagement of the private sector and/or utility with different
innovative options HWTS for sustainable services).
As observed from the response of Bishoftu utility head some utilities are not willing to
accept playing the role of distributing HWTS unless they get official letter from the ministry
of Water or their respective water bureaus. Yet the Bishoftu Utility manager recommended
the opening of safe water shop where still the utility can technically assist. This response
can be shared by some other utilities too. So parallel effort should be on in concluding the
task team effort lead by the ministry of health for finalizing the HWTS solutions as
guideline/strategy based on which letter can be written from the ministry or bureaus for
the utilities to realize the effort uniformly and not with their good will only. Some utility
managers may not feel responsibility for the people they are serving. This can also be
emanated from lack of confidence and limited knowledge about the role and responsibility
of the utility he/she is managing.
Some Utilities may tend to expect to charge the service more than it should be if they do
not understand Aqua for All way of implementation. So we need to clarify the allowable
and not possible areas by taking time to avoid unnecessary expectation but also the
support areas to accelerate the effort by developing realistic proposal. The detail proposal
during development should be participatory or need to be enriched by engaging the
utilities. This should be finalized well before embarking on the pilot launching. The possible
incentive should also be well discussed whether to make it organizational (to the utility) or
to staff engaged in the work by flagging the agenda openly to the utilities.

33
 Harmonization of promotion approach between the private sector and the utility or other
channels is very important not to create confusion.

6.2 Does distribution of HWTS through utilities lead to improved quality of

water (safe water) at point of use sustainably?
6.2.1 Yes for this too because of the following reasons
The reason is that once the community practice and see the benefit they dont come back
to the unsafe use as they consider the danger otherwise for their family health.
The community also value products that they pay for and use it sustainably than free hand
out items like what NGOs give.
This effort is also aligned to health strategy of Ethiopian government which says
prevention is better than curing. This will therefore be supported by the health extension
program. Accordingly there will be follow up and monitoring by all the government
structures.
As responded by the utility manager of Finote Selam and Ambo, for sustained use of safe
water, the community and the utility itself tend to prefer physical filtration (HWTS) option
instead of additives like aqua tabs, water guard, silver dyne and others as responded by
interviewed utility managers. One of the reasons for this preference is absence of clear
manuals and experts (chemists) in majority of the utilities as well as the taste effect and
fear of health risk because of the unsure rate of application. So HWTS which are especially
physical filtration will be means for sustained use of safe water.
As achievement of GTP2 in the short run is unlikely with the given urban population growth
rate, the demand of the users for better quality of life, the level of priority given for the
water supply sector by Ethiopian government, the fact that remaining (unserved)
communities, if they have to get safe water, will rely on high tech and high investment
options (since the low cost and simple technology options are already exhausted), the
sustained use of HWTS for at least the coming 10 years or so is expected.
When people start appreciating the value addition in terms of health impact, everyone will
sustainably use the HWTS and the promotion within communities will follow.
Engaging schools and embarking on SWASH program is also important for scale and
sustainability of using HWTS. So if the pilot allocates an approach budget for SWASH
program its impact on sustainability will be significant and there will be outreach.
The fact that all WASH sector actors (Health, Municipality, Water/utility, mayor/woreda
administrator and finance and economic development office) at the towns and woredas
will be engaged with the capacity building and awareness raising trainings right from start
will ensure sustained use of the options but also contribute for scale including budget
allocation and/or fund raising from their partners like WaterAid, UNICEF, SNV and other
NGOs
The utilities may own the intervention to the extent of importing the HWTS by government
The current emergency created has been an opportunity for promoting the need to use
water filters at point of use. So for sustaining the awareness that will be created it is
important if the private sectors continue the promotion work.

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 6.2.2 Perceived challenges and recommended mitigation
The level of acceptance of HWTS options vary from town to town depending on the
existing safe water availability and challenge both in terms of access and water quality. So
the scaling up of using utility distribution channels should be phased approach and with
proper monitoring system by taking in to account sustainability as end in mind.
As Aqua for All support level will be as enabler and will not remain in the pilot area long,
the approach should be to let the utility sit on the drivers seat with proper and systematic
monitoring for sustained use of the technology
The level of demand that will be created may not be sustainable after the emergency
situation (AWD) is under control unless the utility continues the advocacy as the day to day
business of the organization. So there must be plan to ensure this.

6.3 Is engagement of utilities in HWTS distribution a better and viable

option to reach vulnerable target groups?
6.3.1 Yes it is a better and viable option for reaching vulnerable target groups better
than through the private sector
The reason is that, as government entity, utilities are responsible bodies to reach everyone
in the respective town. So the mayors office and the utility will use their means including
installment and other methods as they used to do so in pipe line installation for HH
connection. Water supply is taken as good governance (political) agenda for politicians and
sector leaders these days. So the vulnerable groups will be better targeted regardless of
how much it costs for the utility.
There is already experience of installment and reaching vulnerable groups at utilities level
as indicated by Finote Selam and Debre Markos Utilities in the supply of pipe network
systems through installment systems.
The engagement of actors like Aqua for All and other NGOs like WaterAid in the pilot
towns will be an opportunity to ensure that this is happening through the monitoring
system and multi stakeholders plat form to be realized. N.B. that Water is working in both
the chosen towns for the Pilot(Ambo and Finote Selam)
There will also be multi-stakeholders forum that will include NGOs, Integrated Urban
WASH forum (IUWF) as well as citizens forum.
In the Ethiopian condition water tariff payments by communities (that may include
installment payback portion if there is unpaid balance) is not a choice since the penalty will
result in water cut-off. So no doubt the payback is promising.
We will also explore possibilities of linking with the nearest credit institutions if the
demand for installment exceeds what we avail from A4A in supporting the installment
budget for the pilot
We will also explore possibilities of inclusion in their business plan to sustain the thinking
6.3.2 Perceived challenges for the vulnerable groups and mitigation option
Dependency syndrome developed by users through some NGOs free hand out approach
that will create reluctance to payback for some users that will received HWTS through

35
 installment. This will be mitigated through enough pre-intervention awareness creation by
Aqua for All and the utility team clearly.
Some utilities, as responded by Adama utility, do not have installment approach even for
water supply network installation as guideline. So installment can be new for some utilities
unless Aqua for All and other actors can influence and ensure equity and inclusion for
vulnerable groups.
As indicated by Adama Utility where the water supply source is from Koka dam, the
potable water supply challenge is chemical problem like fluoride and others. So HWTS do
not solve every problem alone and require additional chemical treatment. This makes the
level of acceptance and its viability utility specific.
Some communities may show less interest when they feel that their expectation and the
product service level are not the same. The try and buy approach may give us lessons.
If there is no harmonized approach among NGOs and the private sector, the way
vulnerable groups will be reached can be challenging and difficult to manage. So local
government authorities (LGAs) and other actors must work towards harmonized
approaches.

6.4 Under which conditions does distribution of HWTS through utilities

lead to hygienic behavior (correct usage of the products)?
6.4.1 The prevailing conditions for leading to hygienic behavior
The condition of HWTS distribution through utilities can lead to hygienic behavior as long
as there is integration of the effort with health office.
As was indicated by the health office head of Finote Selam Ato Mebratu, Town health
office is working through integration with water (utility) and education (WASH offices) and
the health extension workers are ready to provide the required hygiene education. Still he
has confessed that the level of integration is not to the desired level.
When promoting HWTS value addition by health extension workers, the utility experts and
other the fact that HWTS are serving at point of use makes the theory of change
acceptable and ensure hygienic behavior.
6.4.2 Perceived challenges and mitigation measures
In the Ethiopian context there is no trust by marketing promotion through private sectors.
The people say seeing is believing. So what is very important is that, the approaches of
using the utility channel for HWTS should be development agenda and central for
contributing to safe water access for the community and water quality improvement;
instead of the business to lead the development. This assumption may be confirmed
through the try and buy approach in other areas as well.

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7. INITIAL RESEARCH QUESTIONS: DESK STUDY
Questions to be answered to prepare for the pilot

7.1 Role of the utility

7.1.1 Cost/benefit calculations
What is the impact on the business case of utilities of taking up a task in HWTS
promotion and distribution?

Suppose 500 Tulips HWTS products are distributed:

The promotion cost will be awareness creation workshop and displays on public
meetings for the users including transport cost (in different villages at different
times) about Birr 10,000
The usage manual (demonstration at every HH level and at office level) for those
who have shown interest daily subsistence allowance (DSA) for utility technicians
and community promoters and motor cycle/vehicle fuel expenses: Birr 5,000.
The cost of awareness creation and planning workshop for the decision makers
which will be directly by Aqua for All with the support of the utility will require about
Birr 20,000.
So total capacity building budget will be Birr 35,000
The unit cost of one Tulip at Finote Selam from supplier including their service
charge is Birr 395 or 18 USD; and for spare =Birr 132or 6 USD
The total cost of 500 filters (excluding spare)at Finote Selam = 500*395= Birr
197,500
If 10% profit margin is included= 197,500+10%*197,000= Birr 217,250
Total profit from 500 filters = 217,250-197,500= Birr 19,750; if 1000 filters =Birr
39,500
This means that each HH will buy one Tulip filter with Birr 434.50 only. The utility will
have a profit margin of Birr 39,500 for promoting and distribution of 1000 Tulip
water filters where the budget required for promotion and distribution is covered
from the profit generated. (1)
The second scenario will be that the filters can be covered by the pilot budget for
the sake of promotion and the unit price of filters will be only Birr 395 without profit
margin (not encouraged as this will not be market lead)
7.1.2 What will be the interest of the utility
From their role as public entity providing access to safe drinking water:

The purpose of establishment of utilities is as public entity to play the role of accessing
drinking water for the inhabitants and function as Drinking Water Company. That means
that they are in charge of availing enough potable water for the town inhabitants all times
without compromising quality. To do this task, they have structure and placed staff with
different disciplines including; Utility manager, electro mechanics staff, chemists to take

37
 care of water quality monitoring and water treatment, water engineers, hydro-geologists,
technicians, plumbers, community workers, accountants, administration staff, security
guards, drivers and others. The salary of utilities is covered from the profit they collect as
Business Company which also determines the rank of the utility. (The number of staff varies
from utility to utility depending on the size of the town and the work load. For example in
Adama there is 300 permanent and 200 temporary staff (totals 500); while Finote Selam has
46 permanent and 2 temporary staff (which totals 48)). But even with all this staff size the
utility could not reach every one everywhere as needed. Therefore it is believed that with
the inclusion of HWTS which serves at point of use (even better than the existing utility
supply service in terms of quality); they can make it and therefore, it will interest them to
be comprehensive in their service and fill important gaps.

In addition, when the promotion and distribution of HWTS is to be managed by a utility, the
interest of the utility will be that, they will reach the community with additional solutions
that will mitigate the turbidity and bacterial problem as well as access for the unserved ones
without additional investment (even they can make profit out of the intervention). They will
also have answers for such questions which existed before long but were beyond their
capacity to mitigate. (HWTS are ideal for the rural communities too because of the
dispersed settlement pattern of communities among other reasons). So as the utility is the
sole drinking water supplier company, HWTS helps to respond to the pertinent water
quality issues apart from access but also reach the unreached peri-urban dwellers.
Therefore, the plan of HWTS promotion and distribution interests them strengthen their
image/reputation and also contribute for the universal access plan (GTP2). The
diversification of different HWTS products of nearly similar output (in flow rate) and cost
rather complicates/confuses users which one to choose from the other as they (including
the utility promoters) are new for the product now and any long run defects of any product
(in any) which is risky. So while promoting about availability of options with different prices,
it is better to focus on most handy and affordable one product first and plan gradually
phase by phase.
7.1.3 What extra cost would the delivery of HWTS imply for a utility with, lets say 20,000
clients?
Infrastructures (e.g. stock, office space, transport, ):

For infrastructure: a corrugated iron sheet warehouse which will be well furnished internally
for store construction to safely store the HWTS in the compound of the utility may cost about
Birr 70,000; No implication of office space (the utility staff use their own office and no staff for
this purpose will be employed), transport for 6 months Birr 30,000 for fuel cost of motor
bicycles and/or vehicles of the utility, car maintenance and display, etc. So if 20,000 clients
receive the HWTS products the extra cost is estimated as Birr 100,000

Operations (e.g. staff for distribution/marketing/monitoring/complaints),

For the distribution, promoting (marketing), and complaint handling as well as demonstrating
and maintaining of the products, explaining the manual, awareness creation depending on the

38
nature of raw water available (turbidity or bacteriological problem, etc, for the 20,000 clients
an estimated Birr 50,000 is expected for the pilot.

Finance costs: if a payment system would have to be developed to increase the

affordability of HWTS

Yes for ensuring access to all the HWTS should be distributed both in full payment approach as
well as installment approach for those that cant afford to pay once. Through strong, well
structure and consistent promotion the direct selling approach should be given priority.
However, as the product is new and some people could have affordability problem with clear
guideline there should be installment but also voucher system. Once this is well internalized,
there is a credit and saving office in Finote Selam who can avail credit scheme for the needy
ones. This will be one of the assignments to be checked during piloting as they have office in
the Town. The perceived challenge in using Amhara Credit and Saving Institute (ACSI) which is
government affiliated institution is that the interest rate is so high(18%) which makes the cost
of products higher and will discourage generating some level of profit for the utility to sustain
the function. The other challenge is also that the attitude of the users about ACSI is not good
as the way pay backs of credits were made were not good that used force by government.
7.1.4 If these costs would be integrated in the water fee for existing utility clients, what
would this imply at household level?

E.g. (20 l x 5)= 100 l p/d x 365 = 36,5 m3 p/y. If extra costs for HWTS (e.g. initial costs
USD 15 for a filter, finance costs in the case of a credit facility, yearly costs USD 6 for
replacement/cartridge) would be distributed over volume per household per year,
would then the price for safe drinking water be acceptable, and if yes, for which target
groups? For which target groups would the price make HWTS unaffordable?

The current water tariff for Finote Selam is as follows with 4 ladders:

Type of water facility

S.N. Water volume Public water House Hold Government and Business centers
used in M3 point unit unit rate public unit rate Birr/M3
rate birr/M Birr/M3
3
Institutions(Birr/M3)
1. 0-5 7 7 9 9
2. 5.1-10 7 8 10 10
3. 10.1-25 7 9 11 11
4. Over 25 7 10 12 12
Suppose water consumption per person becomes 27l/day which is in line with the access to
Finote Selam (45%(60 lit/ca/day) with a family size of 5 persons, the annual water
consumption becomes = one family uses (27 lit x 5)= 135 lit p/d x 365 = 49,275 lit p/y=
49.275M3/y. If extra costs for HWTS (e.g. initial costs USD 18 for a filter, finance costs in the
case of a credit facility, yearly costs USD 6 for replacement/cartridge) would be distributed
over volume per household per year.

This makes 49.275/12 months= 9.86 M3/month = 9.855*7 Birr/M3 = 70

Birr/month=3.18USD/month

39
When 18+6=24 USD*10% profit by utility is added and distributed for 12 months
=24/12=2USD. The monthly water tariff will therefore be= 2+3.16=5.18USD= 114 Birr/month.

So with one year voucher the Filter and cartilage cost will be covered by majority of the
customers.

Q1. Would then the price for safe drinking water be acceptable?
Yes the price of the safe drinking water will be acceptable.
Q2. If yes, for which target groups?
The target groups that will accept and afford to pay will be for, civil servants, business
people in the town, rich and medium farmers in the peri-urban and town dwellers.
Q3. For which target groups would the price make HWTS unaffordable?

What will not be affordable is for the poorest family members in the town and some in peri-
urban dwellers. These segments of the inhabitants need some level of subsidy.
7.1.5 For un-served households (= households in or near the service area of the
utility with no connection to the grid or other safe source)

What would be the business case for the utility if they distributed HWTS to un-served
households/communities?

For unserved households in or near the service area of the utility with no connection to the
grid system or other source; if they are using raw water HWTS helps them and will be
interested very much. But most likely if they are buying water from private vendors who have
household water connection and/or the public fountain travelling longer distance, their level
of interest may not be as much as the raw water users since they are already paying more and
challenged by the distance of travel. It is assumed that majority of their water needs in each
household are met from raw water by saving the expensive water bought from private vendors
and can show interest since water fee for them is high (the poor pay more) but also are victims
of the turbid and unsafe water in the pipe system like others using the grid system. So the
utility will target these groups too based on their interest, proximity/distance to water
sources, affordable capacity and future expansion plan of the grid system towards these target
groups.
7.1.6 Would distribution by utilities to un-served households lead to increased
acceptance& sustained use of HWTS amongst this target group?
Yes. When unserved communities which could be because of un-affordability or location
distance to grid lines are now served the utility will have increased acceptance by this target
groups but also will result in sustained use of HWTS.

7.2 Role of the Ministry of Health

7.2.1 What should/could be the role of the Ministry of Health in awareness creation /
promotion / regulation? At national level HWTS policy is being developed (WHO and
HWTS Working Group); how is the role of Ministry of Health at local/woreda/kebele
level? Is it possible to engage Health Extension Workers in the promotion of HWTS? If

40
 yes, in which way? Can they eventually do direct promotion like the distribution of
vouchers for HWTS products? Can they be incentivized, for example, by receiving a
voucher themselves?

The ministry of health has three wings of which one is for drugs supply, the other is
promotion and awareness creation and the third one is regulatory and control of food
(water), drugs, medicine and health administration. While the ministry of water is
mandated for the supply of water to the community and possesses its own laboratories, it
is the ministry of health that has regulatory and approval role. Therefore, according to the
Proclamation Number 6.6.1.; the ministry of health is the leading ministry for safe water
supply (considered as food) quality approval. On the other hand, the ministry plays a role
on awareness creation, promotion and development of policies, strategies and regulations
of the health agenda including WASH. That is why currently the ministry is leading the
development of HWTS policy (guideline) along with WHO and HWTS working group. Once
this regulation is developed it will be a working document to be cascaded to its rural and
urban structures like the Regional Health Bureaus, Zonal health departments, Town health
offices, woreda health offices and kebeles. The health extension workers assigned in
kebeles and Towns can play a role of promoting HWTS along with their health extension
program packages. But I am not sure about distribution of HWTS by themselves and
engage in voucher system or installment since they are not established as business model.
Incentivizing them for promotion may be possible by involving in capacity building and
awareness raising as well as integration with utilities approach. But it may not be possible
for voucher distribution of HWTS products as it may create conflict of interest for
government employ whose budget is exclusively covered by government and not for profit.
The Finote Selam utility manager has also advised that the delivery channel, cash
collection, installment and voucher system must be only in one channel that is the utility
office. But he recommends the integration with health office including the health
extension workers under it for the promotion of HWTS and its added value.

So still the support of the Ministry of Health for the HWTS distributed through Utility is
still very important at different levels as follows:

The Town health department under the mayor will provide awareness creation for the
inhabitants with its health staff including town health extension workers
As one of the decision maker of the Mayor cabinet members the head of health can
endorse the new approach of distribution of HWTS through utilities,
Support laboratory check as an evidence of the existing water quality problem so that
the users will convince themselves and help the demand creation.
Since HWTS products serves at point of use and are very much relevant to the health
extension program agendas, the contribution of health office/department is
indispensable and will be promoted more professionally.

7.2.2 Does/can Ministry of Health have a role in monitoring access to Safe Water?
According to the Federal Ministry of Health water quality monitoring and surveillance
strategy, developed in May 2011; the ministry engages in the monitoring of safe water

41
 quality through its hospitals, the health centers, laboratories for water quality check and
surveillance, as per the proclamation. But in actual practice the current engagement level
is most likely those mentioned above and needs further strengthening.
7.3 Role of Private Sector
7.3.1 Suppliers of HWTS normally do their own marketing. In the case of utilities being
involved in promotion/distribution, what would be respective roles, responsibilities, risks
and profit margins of each of the stakeholders? For example: in promotion, marketing,
stock, sales, distribution, client support, complaints & claims, monitoring.
The suppliers in this approach should sign tri-party partnership agreement with Aqua for All
and the utility with well defined modalities. The costs in one year may need to be constant, the
way promotions are being done may need to be consistent and read each other and above all
the role of A4A should not be considered as the marketing wing of the suppliers but rather
should be seen as development partner of Ethiopian government with innovative approach to
meet/support GTP2. Based on the agreement signed any question arising on complaints,
supply timely of parts and HWTS as per the created demand how the installment and voucher
system will be managed there will be a separate detailed agreement during the piloting phase
and can go beyond unless the utility decide to directly order import from the suppliers. Also
some level of training and manual availability for the utility are areas of the agreement and
should be binding as the private sector is also benefitted from the created demand and bulk
purchase.

7.3.2 To stimulate successful market development, costumers need to have a range of

options to choose the HWTS product most appropriate for their own situation and their
own likes (appropriate in relation to size of the household (flow rate), affordability,
aspirations,). In the pilot, a basket of HWTS should be made available, each with a manual
in the local language, and with appropriate information about characteristics, usage, costs,
advantages and disadvantages of each option. Which options would together constitute an
appropriate basket for households with different economic situations, likes and aspirations?
E.g Ceramic pot filter, (Tulip) Siphon filter, (Tulip) Table Top filter, LifeStraw, Lifestraw
Family filter, Sawyer, Soyer, chlorine solutions (PUR, Bishan Gari, ). Are these options
acceptable for Ethiopian government? Are (some of these) options available at local shops
or pharmacies - in which urban centers?
All of the HWTS solutions are available in Ethiopian market even if there was shortage
currently following the AWD created in Addis Ababa, and some regions. The options are
acceptable and are good choices in the long run. But during the pilot phase we need to focus
on one or two options that are affordable and easy to manage (handy) but also respond to
family size. This will help not to confuse the users for deciding which product to buy. It is also
possible to reconsider this judgment during the course of the pilot if especially civil servants
and business people demand for other choices. So the way of promotion (messaging) should
be well planned and be clearly understood by the promoters.

7.4 Affordability: payment in installments

7.4.1 Is there a credit facility in place which can provide loans to purchase HWTS products?

42
As explained above there is credit system available but very expensive interest rate (18%)
which may not motivates users as they have bad experience the way credits are paid back by
this credit institution apart from the high interest rate. The utility has also reservation on
linking this institution to help the effort for success based on the already created attitude by
the community towards this institution (particularly the way loans are returned)

7.4.2 Is it feasible to develop an in-house credit facility for utilities?

Yes if the HWTS products are not purchased and handed over to the utility initially to be paid
back over time either by Aqua for All or the suppliers with defined agreement I mentioned
above. Still this should be planned any way as the demand may be huge and breakthrough that
need to be prepared well to reach every one and smooth distribution inclusively.

7.5 Affordability: use of a voucher systems

7.5.1 If households would receive a voucher to buy a HWTS from a choice of options;
would this potentially lead to sustained use of HWTS?
As in detail explained above, yes in the long run; but we should limit choice to avoid confusion
to choose one from the other by users initially. But it will help in the long run for sustained use
of HWTS by giving options but also through voucher system to each though with limited
income for direct purchase.

7.5.2 If households receive a Household Filter/chlorine solution for free/with reduced prices,
would they be willing to buy a yearly cartridge?
Not sure yet. Even if affordable prices are always good until people start to appreciate and
want to use them sustainably, the demand for yearly cartilage right from start may not be
practical. Yet it needs to be assessed during the piloting phase by giving them options.

7.5.3 Would it be possible to make HWTS options available at the utility, and have people
using a voucher to get/buy them (reduced price, for free ())
Yes that is what this study is recommending and the pilot need to go to. Free hand out should
not be encouraged as people do not appreciate and value things they receive freely but also
the system must work across by treating every one uniformly with business model and avoid
dependency syndrome.

7.5.4 Which parties could be interested in the outcome of safe water, and thus, willing to
invest in a voucher system? E.g. donors of the Ministry of Health, NGOs, impact
investors with an interest in healthy people as potential clients for their products.
Local government authorities (as client and as responsible organ to serve the people in safe
water); NGOs operating in the area particularly in WASH and Health like WaterAid; donors who
are clear on the added value of HWTS that serve at point of use; the end users (community)
and the private sectors in the value chain for job creation, after sales services, business people
who may take over the distribution with marketing approach. Because in the long run
government should focus on regulatory role and such tasks should be done with market lead
(business model). Even if utility is still business entity, it may sub grant or delegate the after
sells service or encourage the establishment of safe water shop.

43
7.6 Payment of the Pilot
7.6.1 To test the feasibility and affectivity of HWTS distribution through utilities, the
approach will have to be developed for and implemented in one or more utilities.
Yes this recommendable and this study recommends starting in two utilities (Finote Selam and
Ambo) at the same time if the budget allows but if there is limitation of budget to start only in
one pilot (Finote Selam)

7.6.2 For the pilot we are thinking of maybe using a voucher system (e.g. with a value of USD
15) with which households can go to a shop (or utility office) to get a HWTS for free, or
with discount if they prefer a more expensive model.
According to agreed opinion with Finote Selam utility, the HWTS will be availed to the utility
only with current market price (18 USD) for (Tulip) Siphon filter, (Tulip) Table Top filter,
LifeStraw, Lifestraw Family filter with their market price (but limiting in the number of choices
to avoid confusion). No free hand out except there is any exceptional reason for community
approved the poorest of the poor as development practitioner.

7.6.3 For the pilot, there are some, but not enough, resources (cash and in kind) available
within the Antenna/Aqua for All/SDC project Safe Water II.
That is where the pilot budget is expected to start implementation as soon as possible.

7.6.4 We are thinking of asking different parties to contribute (cash or in kind) and thus,
share the costs of the pilot: Antenna, Aqua for All, IRC, SDC, VEI, WaterAid ()
The assessment made in WaterAid and SNV at the moment has shown that, it less likely to get
financial support for the pilot. But there will be significant contribution in capacity building,
awareness creation and partnering technically with WaterAid as both Finote Selam and Ambo
are WaterAid intervention Towns.

7.6.5 Important for this approach is to accompany the distribution of vouchers with
awareness creation and monitoring, to ensure that this incentive will lead to a
sustained use of HWTS. This implies that people will have to buy a cartridge to
replace the initial filter element at the end of its functional lifetime. The cartridge
will have to be available near the consumer: at the utility office/shop. Utility will do
the invoicing for the cartridge (included in water bill, or otherwise)
Regarding this approach, I have well discussed, understood and agreed with the utility and
town level decision makers including the mayors. The pilot design should also take in to
account this approach while allocating budget for different budget lines.

7.6.6 After the pilot phase, new clients will have to pay for the initial HWTS device
unless there are stakeholders who are willing to subsidize a voucher system at a
wider scale when the test has proven to be successful. Maybe Ministry of Health has
sponsors with this interest? Impact investors with an interest in health outcomes?
Yes this is the theory of change and conceptually agreed except that the products fail to sell
themselves. The study team believes that as long as the promotion is well done, the HWTS
products are fully used and the health change/impact is realized by the community, new

44
clients will and the intervention will be scaled up. That is what is for now in the hands of the
town since getting partners or impact investors in the towns for no is not sure yet for the
voucher system. For installment and collecting the costs along with water tariff will continue as
system. The current experience of the utility towards installment approach is that for civil
servants, they come up with support letter from the organization they work and their
employer organization ensures payment. Also civil servants come with other civil servant to
sign for payment as collateral and this is legal to force the repayment and get the payback, the
last and most important approach is to fully pay initially which is very much encouraged by the
utility and if there is affordability issue to go for the cheaper price ones like Tulip.

8 MONITORING
To measure the output, outcome and (potential) impact of this pilot, a monitoring system has
to accompany the pilot.
Main question to be answered through this pilot is whether HWTS distribution through utilities
leads to increased acceptance of HWTS. Further, monitoring will be done on behavior change
and health effects. For this matter, a range of frameworks and survey questions are available
within the HWTS network, at WHO level. However, for this pilot they will have to be adapted
to this specific situation. Aqua for All will support this part of the pilot by supplying specific
expertise and human resources for this matter.

o Does distribution of HWTS through utilities lead to increased acceptance of HWTS?

o Does distribution of household water filters and filter replacements/cartridges through
utilities lead to sustained use of safe water?
o Is engagement of utilities in HWTS distribution a viable option to reach vulnerable target
groups)?
o Under what conditions does distribution of HWTS through utilities lead to changed
hygienic behavior?
o Under what conditions does the sustained use of HWTS lead to a positive health impact?
The survey questions mentioned here are very important key performance indicators to be
monitored during the piloting phase. The desk research has also tried to preliminarily assess
the 5 questions above and has tried to respond what the end result would look like. The
piloting phase and the monitoring system to be installed and budgeted will inform the final
result any ways. Please refer the initial research questions, responses.

45
 8.1 For the implementation of the a pilot to test this approach, the following
assumptions are made:
1. The filters with the market price will be availed by private sectors where there will be
internal MOU among Aqua for All and the dealers in country with the utility
2. The schools are very well targeted for getting the services in schools which are needy and
are convenient for proper use and training but also have a lot of scaling up effect including
for rural set up.
3. Water, Health, Education and finance office are WASH MOU signatories in the country at
all levels for WASH in integration but also lead by the mayor/woreda admin as WASH
structure.
4. The role of health extension workers is well thought off and will be flexibility
accommodated as the situation and the leadership of health office with the utilities for the
initiative allows
5. It is assumed that instead of employing permanent staff for the pilot in the utility office
there will be top up payment for 8 staff of the utility from 800 to 1200 Birr per person per
month depending on their level of engagement for the work. These staff include the utility
manager (1), from finance, the process owner, income officer and cashier (3), from water
supply section, the process owner and technician who are demonstrating, explain the
manual and train after how to manage the HWTS but also advise about after sales service
and maintain (2); the store keeper (1), public relation of the utility who is engaged in the
planning along with the utility manager but also promoter of the products for citizens
forum, in workshops, in community gatherings, etc. (1).
6. As the budget ceiling secured is now concluded to be only 60,000 Euro, only one utility
(Finote Selam will be considered) with full piloting and the consultant support days are
adjusted accordingly. Actually we have also agreed that, we will try to do some works in
the second Utility Ambo with some budget lines by saving from Finote Selam at least
private sector engagement with the Local government authorities for supply of the HWTS,
awareness creation and capacity building to the LGAs, water quality test and monitoring
the progress, etc.
7. In general there will be room of flexibility for pilot activities as the situations push for more
success and leverage but also to target rural communities as well, where rural government
structure can be accommodated.

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9 CONCLUSION AND RECOMMENDATION
9.1 Conclusion
The effort of Ethiopian Government to reach everyone everywhere with sustainable WASH
services by developing ambitious plans is commendable and significant change is registered
especially in the last 15 years. However, because of the weak capacity of the government
structure at all levels for implementation and sustainably manage the facilities completed by
users; absence of integration and harmonization of approach among actors; the scattered
settlement pattern of the communities, un availability of different options and solutions
depending on the context of the area under consideration; the spatial and temporal
distribution of water resources potential of the country; and above all, the size of the
population of Ethiopia (over 100m now) with alarming population growth rate; the current
water supply coverage of the country is not more than 58% leaving 42m people unserved. As a
result, while prioritization of the WASH sector with political will and commitment is the corner
stone for achieving the expected success (the universal access) by Ethiopian government,
there should be different technology options and innovative solutions for house hold water
treatment and safe storage that will serve at point of use.

This desk research is planned and commissioned by Aqua for All to test the possibility and
value addition of promotion and distribution of HWTS through Water Utilities in Ethiopia and
design piloting programme to test on the ground for scaling up in the country and globally.
Both the positive responses as well as reservations by the utilities regarding utilities
appropriateness for promotion and distribution of HWTS are equality important learning in
order to draw recommendations and start pilot on the ground.

9.2 Recommendation
The following are general recommendations given by the utilities and the study team:

1. It is advisable to start the pilot in the most welcoming utilities because of their capacity,
with felt need, previous relation and confidence they have built with the supporting NGO,
good leadership integration and who prioritize WASH
2. There should be enough awareness creation exercise by the piloting team about the
product for decision makers to get political will and endorsement but also down to all
WASH structures
3. Similar training should be given to community by Utility staff, health extension workers, and
Town WASH office (utility, health, Education/school and municipality) focal staff and this
should be monitored about the level of awareness and create demand including the
different payment modalities
4. Availability of users manual, after sales service with involvement of private sector, retailers
and distributers that will benefit from profitable supply chain and avail affordable HWTS
products is very important and mandatory which should also be demonstrated repeatedly

47
 so that the product can sell itself in the future. The awareness creation and display may be
at the citizens forum, at utility office and also house to house.
5. It us recommended that good pre-intervention planning and strategic thinking and enough
capacity building (awareness raising training) is the stepping stone for ensuring the success
which could also have the potential of leverage like reaching the rural 39 kebeles (wards),
all schools and neighboring woredas and towns.
6. While the primary after sales service and keep the spares is initially the utility, to plan and
develop system for linking with a maintenance organ (private sector actors, suppliers, etc) is
very important that will stand by its own.
7. Supportive monitoring and supervision by the cabinet members; including ensuring that
those engaged in the promotion need to be evaluated against in the long run since this will
be the one of the day to day business of the utility office.
8. As the pilot town is zonal town, it is important to engage other woredas officials for
learning the best practice for scale up effect and benefit from this as well as receive
feedbacks for future actions

48
10. REFERENCES:
1. EDUCATION FOR ALL, Special Needs and Inclusive Education in Malta
Annex 2: Desk Research Report EUROPEAN AGENCY for Special Needs and
Inclusive Education
2. MANAGEMENT OF MARKETING METHODS OF MARKET RESEARCH LEARNING
INTENTIONS/SUCCESS CRITERIA
3. Water quality analysis in emergency situations - Oxfam Spain
4. WHO International Scheme to Evaluate Household Water Treatment
Technologies Question and Answer guide
5. Water Quality Policy WaterAid Ethiopia, July 2014 Addis Ababa Ethiopia
6. Results of Round I of the WHO International Scheme to Evaluate Household
Water Treatment Technologies
7. A toolkit for monitoring and evaluating household water treatment and safe
storage programs
8. Water Testing Technical Brief (Oxfam)
9. Toolkit WHO, UNICEF, HWTS Monitoring (2012)
10. National drinking Water Quality Monitoring and Surveillance strategy - (May
2011)

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