Dual system of water safety plan auditing in Hungary: benefits and lessons learnt.

A risk-based approach is recognised worldwide as the most reliable means for the provision of safe drinking water. Efficient implementation of the water safety plan (WSP) approach, recommended by the World Health Organization (WHO), is facilitated by an auditing framework. In Hungary, development of WSPs is a legal obligation for water suppliers. WSPs are subject to a two-stage regulatory audit, a consultative central technical audit and a formal local audit. In 2019, a survey was conducted in cooperation with WHO to evaluate audit experiences of over 1,200 WSPs. Recommendations from the central audit significantly improved coherence and compliance of WSPs, confirming the efficiency of the dual approach. The use of a WSP template provided by the national authority further increased consistency and reduced time and work demand of the audit. Both water suppliers and public health authorities indicated a need for further capacity building on WSP development and auditing. The main challenge for water suppliers is the identification and risk assessment of hazards associated with the water source and distribution within premises. The recast European Union drinking water regulation is expected to accelerate the uptake of WSP and strengthen linkages to water catchment management and water safety in buildings.

Water, sanitation, and hygiene services in health care facilities in the Autonomous Province of Vojvodina, Serbia.

Provision of safe water, sanitation, and hygiene (WASH) services in health care facilities is a priority at the global, national, and local levels. To inform improvements planning, conditions of WASH, waste management, and environmental cleaning were assessed in 81 facilities in the Autonomous Province of Vojvodina, Serbia, as part of a nationally representative survey in 2019. The survey included on-site checks, structured interviews, and drinking-water quality analysis. WHO/UNICEF indicators for WASH service levels and an advanced service level defined at the national level were applied. The results showed that all investigated facilities provided basic water services; 94% of facilities provided basic hygiene and waste management services; 58 and 2%, respectively, provided basic cleaning and sanitation services. Only 1% of investigated facilities met the basic level for all five WASH dimensions. Advanced service levels were only met for hygiene, waste management, and/or cleaning in 15-38% of facilities. In 33% of health care facilities, drinking-water quality was not in compliance with the national standards. The results revealed that there is a need for increased awareness and efforts to ensure basic provisions for sanitation, environmental cleaning, and drinking-water safety.

Tracking progress on health and climate change in Europe.

Left unabated, climate change will have catastrophic effects on the health of present and future generations. Such effects are already seen in Europe, through more frequent and severe extreme weather events, alterations to water and food systems, and changes in the environmental suitability for infectious diseases. As one of the largest current and historical contributors to greenhouse gases and the largest provider of financing for climate change mitigation and adaptation, Europe's response is crucial, for both human health and the planet. To ensure that health and wellbeing are protected in this response it is essential to build the capacity to understand, monitor, and quantify health impacts of climate change and the health co-benefits of accelerated action. Responding to this need, the Lancet Countdown in Europe is established as a transdisciplinary research collaboration for monitoring progress on health and climate change in Europe. With the wealth of data and academic expertise available in Europe, the collaboration will develop region-specific indicators to address the main challenges and opportunities of Europe's response to climate change for health. The indicators produced by the collaboration will provide information to health and climate policy decision making, and will also contribute to the European Observatory on Climate and Health.

Montenegro makes important strides towards achievement of the SDGs.

In 2018, Montenegro took an important step towards ratification of the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. A multisectoral national consultation provided a forum where national stakeholders could assist in related decision-making. The Protocol is the first and only multilateral legal agreement linking sustainable water management and the prevention, control and reduction of water-related diseases in the pan-European region. It was adopted in 1999 at the Third Ministerial Conference on Environment and Health in London and entered into force in 2005 as legally binding for the ratifying countries. To date, 26 countries have ratified it, covering about 60% of the population of the pan-European region. Montenegro is on the way to becoming the next country to ratify it and has used it as an instrument to strengthen national action towards progressively reaching regional and global WASH-related commitments, specifically in relation to SDG 3 (good health and well-being), SDG 6 (clean water and sanitation) and the Ostrava Declaration on Environment and Health (2017).

Implementation and evaluation of the water safety plan approach for buildings.

The World Health Organization (WHO) promotes water safety plans (WSPs) - a risk-based management approach - for premise plumbing systems in buildings to prevent deterioration of drinking-water quality. Experience with the implementation of WSPs in buildings were gathered within a pilot project in Germany. The project included an evaluation of the feasibility and advantages of WSPs by all stakeholders who share responsibility in drinking-water safety. While the feasibility of the concept was demonstrated for all buildings, benefits reported by building operators varied. The more technical standards were complied with before implementing WSP, the less pronounced were the resulting improvements. In most cases, WSPs yielded an increased system knowledge and awareness for drinking-water quality issues. WSPs also led to improved operation of the premise plumbing system and provided benefits for surveillance authorities. A survey among the European Network of Drinking-Water Regulators on the existing legal framework regarding drinking-water safety in buildings exhibited that countries are aware of the need to manage risks in buildings' installations, but experience with WSP is rare. Based on the successful implementation and the positive effects of WSPs on drinking-water quality, we recommend the establishment of legal frameworks that require WSPs for priority buildings whilst accounting for differing conditions in buildings and countries.

Priorities for protecting health from climate change in the WHO European Region: recent regional activities.

Evidence of the impact of climate change on health is growing. Health systems need to be prepared and gradually adapt to the effects of climate change, including extreme weather events.Fossil fuel combustion as the driver of climate change poses a tremendous burden of disease. In turn, cutting greenhouse gas emissions in all sectors will achieve health co-benefits. If all countries meet the Paris Agreement by 2030, the annual number of avoidable premature deaths could total 138,000 across the entire European Region of the World Health Organization (WHO).Several international frameworks promote a stronger commitment by countries to implementing the necessary adaptations in the health sector and to addressing health considerations in adaptation measures in other sectors. The WHO has a mandate from its member states to identify solutions and help prevent or reduce health impacts, including those from climate change.National governments are continuing to establish public health adaptation measures, which provide a rationale for and trigger action on climate change by the health community. Effective national responses to climate risks require strategic analyses of current and anticipated threats. Health professionals need to play a proactive role in promoting health arguments and evidence in the formulation of national climate change adaptation and mitigation responses. To this end, country capacities need to be further strengthened to identify and address local health risks posed by climate change and to develop, implement and evaluate health-focused interventions through integrated approaches. Building climate-resilient and environmentally sustainable health care facilities is an essential pillar of health sector leadership to address climate change.

Participatory approaches to reaching the Sustainable Development Goals: Montenegro: working towards SDG 6 and ratification of the Protocol on Water and Health

In 2018, Montenegro took an important step towards ratification of the “Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes” (hereafter, “the Protocol”). A multisectoral national consultation was held with the overall aim of facilitating the process towards Montenegro’s accession to the Protocol. This provided a forum where national stakeholders could assist in related decision-making. The consultation was triggered by the “Iceland Statement. Ensuring safe and climate-resilient water and sanitation” (2018), according to which the small countries committed to acceding to the Protocol by 2022. The Protocol is the first and only multilateral legal agreement linking sustainable water management and the prevention, control and reduction of water-related diseases in the pan-European region. It was adopted in 1999 at the Third Ministerial Conference on Environment and Health in London and entered into force in 2005, becoming legally binding for the ratifying countries. To date, 26 countries have ratified it, covering about 60% of the population of the pan-European region. The United Nations Economic Commission for Europe and the WHO Regional Office for Europe provide the joint secretariat of the Protocol. Montenegro is on the way to becoming the next country to ratify it. The Protocol is recognized as an instrument for use in strengthening national action towards progressively reaching regional and global WASH-related commitments, specifically in relation to SDG 3 (good health and well-being) and SDG 6 (clean water and sanitation) and the “Ostrava Declaration on Environment and Health” (2017). It stipulates the importance of formulating national priority targets and implementation plans, while promoting a whole-of-government approach to and coordinated intersectoral action in doing so.

Plan de gestion de la sécurité sanitaire de l’eau : guide pratique pour l’amélioration de la sécurité sanitaire de l’eau potable dans les petites communautés

Selon les Directives de qualité pour l’eau de boisson de l’OMS, la mise en place d’un plan de gestion de la sécurité sanitaire de l’eau (PGSSE) constitue l’approche la plus efficace en vue d’assurer une alimentation continue en eau potable. Même si l’alimentation en eau potable dans les zones rurales et les petites villes ne cesse de poser d’importants problèmes dans l’ensemble de la Région européenne de l’OMS, l’approche PGSSE s’est révélée efficace pour les systèmes d'approvisionnement en eau à petite échelle. Le présent guide pratique vise à faciliter la mise en oeuvre du PGSSE dans les petites communautés en fournissant de courtes explications sur ce processus et des modèles pratiques utilisables sur le terrain.

Ситуация в области водоснабжения, санитарии и гигиены в школах в Общеевропейском регионе

Доступ к надлежащим услугам водоснабжения, санитарии и гигиены (WASH) – это неотъемлемое право каждого человека, в том числе и каждого ребенка. Обеспечение доступности этих услуг в школах предусмотрено Повесткой дня в области устойчивого развития на период до 2030 г. и является приоритетной задачей Протокола по проблемам воды и здоровья к Конвенции об охране и использовании трансграничных водотоков и международных озер 1992 года. В данной публикации приводятся общие сведения о положении дел в области водоснабжения, санитарии и гигиены в школах стран Общеевропейского региона. Фактические данные получены из научной литературы, национальных и международных исследований, а также на основании изучения материалов ситуационных исследований. Они свидетельствуют об определенном прогрессе в политике и выполнении целевых показателей, связанных с WASH, но при этом указывают и на то, что этот прогресс не приводит к надлежащему развитию таких услуг в школах. Пробелы и трудности в этой сфере могут быть обусловлены ненадлежащими стандартами, неэффективной координацией усилий и неадекватными показателями для мониторинга и надзора. Более того, во всем регионе наблюдаются неравенства и несправедливые различия, которые часто не получают должного внимания. Состояние систем WASH не соответствует целям, которые ставились в стратегиях, равно как и потребностям учащихся, негативно сказываясь на их здоровье, благополучии и школьной успеваемости. Основные проблемы, существующие в регионе, связаны с недостаточной чистотой и обеспеченностью расходными материалами, а также с техническим обслуживанием санитарно-технических сооружений и доступностью безопасной питьевой воды. Для эффективной выработки политики необходимо обеспечить базу фактических данных, в особенности по таким оставленным без внимания темам, как гигиена менструального периода.

Принятие мер на уровне политики для улучшения работы маломасштабных систем водоснабжения и санитарии: инструменты политики и передовая практика в Общеевропейском регионе

Доступ к адекватным услугам водоснабжения и санитарии является важнейшей предпосылкой хорошего здоровья отдельной личности и всего населения. Люди, которые обслуживаются маломасштабными системами в сельской местности и в малых городах, имеют право на такой же уровень охраны здоровья, как и все остальные. Достижение Целей 3 и 6, сформулированных в Повестке дня в области устойчивого развития на период до 2030 г., требует ведения борьбы с заболеваниями, передающимися через воду, и обеспечения к 2030 г. всеобщего и справедливого доступа как к безопасной питьевой воде, так и к адекватной санитарии для всех. Для обеспечения всеобщего доступа необходимо обращать должное внимание на особенности и трудности, которые могут мешать маломасштабным системам водоснабжения и санитарии предоставлять безопасные и устойчивые в долгосрочной перспективе услуги. Улучшение положения дел в таких системах является одной из приоритетных областей деятельности, предусмотренных Протоколом по проблемам воды и здоровья к Конвенции по охране и использованию трансграничных водотоков и международных озер 1992 г. В рамках этой деятельности и была подготовлена предлагаемая публикация. Она предназначена для того, чтобы поддержать принятие действенных мер на уровне политики и способствовать укоренению передовой практики с целью создания благоприятной среды, в которой можно улучшить ситуацию в отношении маломасштабных систем. Публикация знакомит читателя с разнообразными инструментами, которые могут применяться лицами, формирующими политику, и показывает, как эти инструменты можно приспособить к особенностям маломасштабных систем. В ней также представлен целый ряд примеров из практики, в которых иллюстрируется, как страны по своей инициативе предпринимали меры по улучшению положения дел в маломасштабных системах.

Taking policy action to improve small-scale water supply and sanitation systems: tools and good practices from the pan-European region

Access to adequate water and sanitation services is essential for good individual and population health. People served by small-scale systems in rural areas and small towns have the right to the same level of health protection as others. Goals 3 and 6 of the 2030 Agenda for Sustainable Development call for combating of waterborne diseases and for ensuring universal and equitable access to both safe drinking-water and adequate sanitation for all by 2030. To achieve universal access, due attention needs to be paid to the particularities and challenges that may impair the provision of safe and sustainable services by small-scale water supply and sanitation systems. Improving the situation of such systems is a priority area under the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. This publication was developed under the Protocol; it aims to support effective policy action and promote good practices for creating an enabling environment in which to improve the situation of small-scale systems. It introduces a variety of tools that are available to policy-makers and highlights how these can be tailored to the particularities of small-scale systems. It also presents a number of case studies that illustrate how countries have taken the initiative to improve the situation of small systems.

Ситуация в области инфекционных заболеваний, связанных с водой, в Общеевропейском регионе

Протокол по проблемам воды и здоровья к Конвенции по охране и использованию трансграничных водотоков и международных озер 1992 г. направлен на защиту здоровья и благополучия людей путем связи устойчивого управления водными ресурсами с деятельностью по предотвращению, ограничению и сокращению степени распространения заболеваний, связанных с водой. Предотвращение заболеваний, связанных с водой, и сокращение их числа является одним из приоритетов программы работы в рамках Протокола на 2014-2016 гг. В результате обзора имеющихся фактических данных было обнаружено существенное занижение сведений и недооценка реального масштаба распространенности заболеваний, связанных с водой, в Общеевропейском регионе, что указывает на необходимость укрепить национальные возможности в области надзора за этими заболеваниями. К наиболее часто регистрируемым желудочно-кишечным инфекционным заболеваниям, которые могут быть связаны с водой, относятся кампилобациллярный энтерит, лямблиоз, гепатит А и шигеллез. Ограниченные опубликованные данные указывают на то, что примерно 18% расследованных вспышек заболеваний в Европейском регионе ВОЗ могут быть связаны с этим источником. Делаются определенные успехи по установке конкретных целевых показателей по предотвращению и сокращению случаев заболеваний, связанных с водой, и укреплению систем надзора и раннего предупреждения в соответствии с основными положениями Протокола.

The situation of water-related infectious diseases in the pan-European region

The Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes aims at protecting human health and well-being through sustainable water management and the prevention, control and reduction of water-related diseases. Prevention and reduction of water-related diseases is a priority area under the Protocol’s programme of work 2014–2016. A review of the available evidence reveals significant underreporting and underestimation of the true extent of water-related diseases in the pan-European region, indicating a need to strengthen national capacities for surveillance of these diseases. Campylobacteriosis, giardiasis, hepatitis A and shigellosis are the most commonly reported gastrointestinal infectious diseases that could be attributed to water. According to limited published data, about 18% of investigated outbreaks in the WHO European Region may be associated with this source. There has been progress in setting specific targets for prevention and reduction of water-related diseases and for strengthening surveillance and early-warning systems in accordance with the core provisions of the Protocol.

Повышение приоритетности образования, здоровья и благополучия школьников: водоснабжение, санитария и гигиена в школах в Общеевропейском регионе

Невозможно гарантировать хорошее здоровье, благополучие, образование и соблюдение человеческого достоинства школьников, если у них в школе не будет доступа к воде и средствам санитарии и гигиены (WASH) приемлемого качества. Обеспечение всем детям здоровых условий окружающей среды в школах в Общеевропейском регионе является одним из фундаментальных положений Пармской декларации по окружающей среде и охране здоровья 2010 г. Все страны региона обязались к 2020 году обеспечить все центры по уходу за детьми, детские сады и школы безопасной питьевой водой и средствами санитарии и возродить здоровую практику соблюдения правил гигиены. Вне всякого сомнения, именно исходя из прав человека на воду и санитарию и на образование в Повестке дня в области устойчивого развития на период до 2030 г. поставлена цель добиться всеобщего и справедливого доступа к безопасным услугам WASH и создать такие учреждения образования, в которых для всех будет обеспечена безопасная среда для учебы. В сфере WASH главным инструментом политики в Общеевропейском регионе является Протокол по проблемам воды и здоровья 1999 г., цель которого заключается в обеспечении доступа к питьевой воде и санитарии для всех – включая детей в школах. Негативное влияние неудовлетворительного качества системы WASH в школах не ограничивается рамками одного сектора. Здоровье, образование, питание и весь комплекс WASH тесно взаимосвязаны и дополняют друг друга. Эта мысль нашла свое отражение в рамочной основе европейской политики в области здравоохранения – Здоровье-2020, где подчеркивается необходимость улучшения сотрудничества между сектором здравоохранения и другими стратегическими секторами, такими как сектор образования, и осуществления совместных инвестиций этими секторами. Подчеркивая, как неудовлетворительное качество услуг WASH в школах подрывает учебу, здоровье и благополучие школьников, авторы данной публикации настаивают на том, что лица, формирующие политику во всех заинтересованных секторах, должны вынести эту проблему в число приоритетных в контексте Протокола и постепенно реализовывать устремления, сформулированные в Повестке дня в области устойчивого развития на период до 2030 г. и в Пармской декларации по окружающей среде и охране здоровья.

Prioritizing pupils’ education, health and well-being: water, sanitation and hygiene in schools in the pan-European region

The good health, well-being, education and dignity of schoolchildren cannot be guaranteed without access to adequate water, sanitation and hygiene (WASH) in schools. Attainment of healthy school environments for all children in the pan-European region is a core pillar of the 2010 Parma Declaration on Environment and Health. All countries in the region have committed to provide all child-care centres, kindergartens and schools with safe drinking-water and sanitation and to revitalize hygiene practices by 2020. Clearly underpinned by the human rights to water and sanitation and to education, the 2030 Agenda for Sustainable Development aspires to reach universal and equitable access to safe WASH services and create educational facilities that provide safe learning environments for all. The 1999 Protocol on Water and Health is the primary policy instrument in the WASH domain in the pan-European region, aiming to ensure access to drinking-water and sanitation for everyone – including children in schools. The impact of inadequate WASH in schools transcends sector boundaries. Health, education, nutrition and WASH are closely associated and complementary. This is well reflected in the European health policy framework Health 2020, which emphasizes the need for enhanced collaboration and joint investment between health and other policy sectors, such as education. By underlining how inadequate WASH in schools compromises pupils’ education, health and well-being, this publication advocates for policy-makers of all involved sectors to prioritize this in the context of the Protocol, incrementally realizing the aspirations of the 2030 Agenda for Sustainable Development and the Parma Declaration.

The situation of water, sanitation and hygiene in schools in the pan-European region

Adequate access to water, hygiene and sanitation (WASH) is every human’s and child’s right. Ensuring WASH accessibility in schools is encompassed in the 2030 Agenda for Sustainable Development and is a priority area under the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. This publication summarizes the status of WASH in schools in the pan-European region. Available evidence was retrieved from scientific literature, national and international surveys and a desk review of case studies. The data show general progress in WASH policies and targets, but a concurrent lack of translation of this progress into efficient improvement of WASH in schools. Gaps and challenges are found as a result of non-comprehensive standards, inefficient coordination and inadequate surveillance and monitoring indicators. Further, neglected disparities and inequalities are observed through the region. WASH conditions do not reflect policies’ aspirations and are not adequate to pupils’ needs, affecting their health, well-being and performance at school. The main challenges across the region are related in particular to inadequate cleanliness and provision of consumables, as well as maintenance of sanitation facilities and accessibility to safe drinking-water. Policy-making needs to be supported by evidence-based information, especially on neglected topics such as menstrual hygiene management.