Implementing the Clean Clinic Approach Improves Water, Sanitation, and Hygiene Quality in Health Facilities in the Western Highlands of Guatemala.

BACKGROUND: Water, sanitation, and hygiene (WASH) services are cornerstones to providing safe health care services and improving patient satisfaction and care seeking. The Clean Clinic Approach (CCA) uses a 10-step process to support health care facilities (HCFs) in making incremental, effective cleanliness and infection prevention and control (IPC) improvements, without relying on external investments. We piloted the CCA in Guatemala and assessed the extent to which it contributed to quality improvements in WASH for IPC. METHODS: After developing an assessment tool tailored to the Guatemalan context, we assessed 11 HCFs in 8 technical areas and scored the facilities on 79 criteria with a total of 100 points. We conducted a baseline assessment (September to October 2018), second assessment (January 2019), and final assessment (February to March 2019). RESULTS: The 11 HCFs improved their average emergency/general ward scores from 41 points at baseline to 87 points at end line, based on a 100-point scale. For delivery wards, the scores increased from 50 to 91 points and for postnatal wards from 46 to 90 points. CONCLUSIONS: The CCA process and tools facilitated a systematic way for HCFs to identify, prioritize, make, and measure WASH quality of care improvements. Training facility staff was fundamental to improving quality standards, and involving medical and administration staff in joint analysis, coordination, and planning sessions was key to integration and teamwork. Further work is needed to increase involvement of local government and community members and to further adapt the process and tools.

Prevalence of intestinal parasites and the absence of soil-transmitted helminths in Añatuya, Santiago del Estero, Argentina.

BACKGROUND: Intestinal parasites (IP) have been reported in point studies from different provinces of Argentina. The presence of soil-transmitted helminths (STH) was detected in many of these studies, including varied prevalences of all five species of STH in the north were the climate is more appropriate for transmission. Nonetheless, Argentina lacks a comprehensive prevalence map of STH. Therefore, the objective of this study was to determine the prevalence of intestinal parasites, focusing on STH, in rural and peri-urban areas of Añatuya, Santiago del Estero Province and identifying risk factors for their transmission. METHODS: We conducted a cross-sectional survey in the entire population of three rural lots located on the outskirts of the city between March and June of 2015 and among children in a peri-urban neighbourhood of Añatuya city in July 2016. Socio-economic variables, characteristics of the house and stool samples were collected from each household. RESULTS: A total of 470 stool samples were analysed. The prevalence of STH was extremely low, with only 2 people being positive for hookworm and no detection of other STH. The prevalence of IP was 11.7% for protozoans and 11.1% for helminths. IP were significantly more prevalent in pre-school and school-aged children than in adults (P < 0.05). The level of education of adults was also significantly associated with infection (P = 0.001), as well as the practice of informal slaughter of animals (P = 0.002) and the presence of unimproved walls (P = 0.046) and unimproved floors (P = 0.021) in the household. Nonetheless, the only significant predictors of IP in the logistic regression analysis were age (P < 0.001) and main source of electricity (P = 0.026). CONCLUSIONS: The total prevalence of intestinal parasites in the study population was 22.6%. The intestinal parasites detected are transmitted mostly through water (Giardia lamblia) and close contact (Hymenolepis nana), evidencing the need to improve quality control in water facilities and access to improved sanitation to avoid contamination of stored water. The presence of IP was significantly associated with age (with children being more susceptible), households containing unimproved walls and those that did not have access to an electricity network.

A Longitudinal Study of Household Water, Sanitation, and Hygiene Characteristics and Environmental Enteropathy Markers in Children Less than 24 Months in Iquitos, Peru.

Poor child gut health, resulting from a lack of access to an improved toilet or clean water, has been proposed as a biological mechanism underlying child stunting and oral vaccine failure. Characteristics related to household sanitation, water use, and hygiene were measured among a birth cohort of 270 children from peri-urban Iquitos Peru. These children had monthly stool samples and urine samples at four time points and serum samples at (2-4) time points analyzed for biomarkers related to intestinal inflammation and permeability. We found that less storage of fecal matter near the household along with a reliable water connection were associated with reduced inflammation, most prominently the fecal biomarker myeloperoxidase (MPO) (no sanitation facility compared with those with an onsite toilet had -0.43 log MPO, 95% confidence interval [CI]: -0.74, -0.13; and households with an intermittent connection versus those with a continuous supply had +0.36 log MPO, 95% CI: 0.08, 0.63). These results provide preliminary evidence for the hypothesis that children less than 24 months of age living in unsanitary conditions will have elevated gut inflammation.

Development cooperation in water and sanitation: is it based on the human rights framework?

The water and sanitation sector is verifiably receiving increased attention and funding through international development cooperation. Not least because of the way that it affects incentives and institutions in partner countries, development cooperation can have either positive or negative effects on human rights though. The consolidated frameworks for the human rights to water and sanitation is becoming linked to the international community's coordinated development efforts, as evidenced notably in the 2030 Agenda for Sustainable Development. However, a review of major funders' official policies for development cooperation in the sector suggests that many only partially endorse the frameworks for the human rights to water and sanitation. An observation of development cooperation flows to the sector allows the hypothesis to be advanced that worldwide inequalities in access to these services may be reduced through a full and clear application of the human rights framework in development cooperation activities. The article presents findings of this research and explores key stakes for development cooperation in the water and sanitation sector that are relevant for their ability to either negatively or positively contribute to the realization of human rights.

El sector de agua y saneamiento ha recibido creciente atención y financiación a través de la cooperación internacional para el desarrollo. La cooperación para el desarrollo puede tener efectos tanto positivos cuanto negativos sobre los derechos humanos. El hito que consolida los derechos humanos al agua y al saneamiento están articulados a esfuerzos de cooperación para el desarrollo promovidos por la comunidad internacional, como se evidencia en la Agenda 2030 para el Desarrollo Sostenible. Sin embargo, una revisión de las políticas oficiales de los principales financiadores del sector sugiere que muchos de ellos aprueban solo parcialmente los hitos de los derechos humanos al agua y el saneamiento. La observación de los flujos de esta cooperación para el sector permite formular la hipótesis de que las desigualdades en el acceso a estos servicios en diferentes partes del mundo pueden reducirse con la aplicación completa y clara del marco de los derechos humanos en las actividades de cooperación para el desarrollo. El artículo presenta los resultados de esta investigación y explora los desafíos de la cooperación para el desarrollo del sector de agua y aguas residuales que son relevantes para impactar tanto negativamente cuanto positivamente a los derechos humanos.

Demonstration of the Maintaining of the Validated State of a System Used to Generate Water for Injection by Thermocompression Distillation.

Water for injection is used in multiple applications in the biopharmaceutical industry. Regarding this, several methods have been use to generate water with this high quality. Within them, the thermocompression distillation method has been widely employed. However, reports on the maintenance of the qualification and validation status of thermocompression systems used for water for injection generation are non-existent in the scientific literature. Therefore, this paper sought to give results of continuous process verification of a system used for water for injection generation over 2 years analyzing the level of conductivity, nitrate, total organic carbon, endotoxins, and microbiology in 1284 water samples. The main findings were that conductivity and nitrate values were always below the specification limit defined according to the United States Pharmacopeia and European Pharmacopoeia, respectively. The highest total organic carbon value measured was 156 ppb. Regarding the microbiology results, the maximum endotoxin content detected was 0.063 EU/mL and 2 cfu/100 mL. In conclusion, this study demonstrated that the analyzed water for injection system operated under a validated status for 2 years, and it was supported by an appropriate monitoring program according to current process validation guidelines.LAY ABSTRACT: There are multiple methods used to produce water for injection in the biopharmaceutical industry. The thermocompression distillation method has been one of the most used methods for the production of this high-quality water. Nevertheless, to verify maintenance of the validated state of these systems it is necessary to carry out continued process verification of different parameters such as conductivity, total organic carbon, limulus amebocyte lysate, and microbiology according to the mandatory requirements of the United States Pharmacopeia and the European Pharmacopoeia. Therefore, this article presents an example of the application of thermocompression technology to generate water for injection and evidence of continuous monitoring to allow demonstration of the efficiency and reliability of these systems used in the biotechnological industry.

In vivo and in vitro genotoxicity assessment of 2-methylisoborneol, causal agent of earthy-musty taste and odor in water.

The water eutrophication process by phosphorus and nitrogen allows cyanobacteria blooms which promote, among other effects, the generation and release of the metabolite 2-methylisoborneol (2-MIB) in the environment. This substance has been shown to be recalcitrant to conventional water treatment, degrading water quality. Considering the limited number of studies on the biological effects of 2-MIB in eukaryotic organisms, the present study assessed the genotoxicity of 2-MIB using the in vitro comet assay and cytokinesis block-micronucleus (CBMN-Cytome) assay on Chinese Hamster Ovary (CHO) cells and the in vivo Drosophila melanogaster Somatic Mutation and Recombination Test (SMART). The results showed that 2-MIB (125, 250 and 500 µg/mL) was unable to induce gene and chromosome mutations or events associated with mitotic recombination in the SMART. Similarly, four different concentrations (7.5, 15, 30 and 60 µg/mL) of 2-MIB did not induce increments in frequencies of micronuclei, nuclear buds, and nucleoplasmatic bridges in the CBMN-Cytome assay. In the comet assay, the positive results were restricted to the highest dose, 60 µg/mL of 2-MIB. The results obtained may help evaluate the genotoxic profile of extracellular algal products.

Drinking water fluoride levels for a city in northern Mexico (durango) determined using a direct electrochemical method and their potential effects on oral health.

Fluoride is ingested primarily through consuming drinking water. When drinking water contains fluoride concentrations>0.7 parts per million (ppm), consuming such water can be toxic to the human body; this toxicity is called "fluorosis." Therefore, it is critical to determine the fluoride concentrations in drinking water. The objective of this study was to determine the fluoride concentration in the drinking water of the city of Durango. The wells that supply the drinking water distribution system for the city of Durango were studied. One hundred eighty-nine (189) water samples were analyzed, and the fluoride concentration in each sample was quantified as established by the law NMX-AA-077-SCFI-2001. The fluoride concentrations in such samples varied between 2.22 and 7.23 ppm with a 4.313±1.318 ppm mean concentration. The highest values were observed in the northern area of the city, with a 5.001±2.669 ppm mean value. The samples produced values that exceeded the national standard for fluoride in drinking water. Chronic exposure to fluoride at such concentrations produces harmful health effects, the first sign of which is dental fluorosis. Therefore, it is essential that the government authorities implement water defluoridation programs and take preventative measures to reduce the ingestion of this toxic halogen.

A recreational water quality index using chemical, physical and microbiological parameters.

PURPOSE: The aim of this paper was to develop a new recreational water quality index (RWQI) as a tool to ensure the health of swimmers and to take practical decisions. METHODS: RWQI was elaborated with epidemiological data, and we carried out an exhaustive study of the different guidelines for recreational waters proposed by different organisations around the world. Different parameters were chosen, considering, as a priority, the swimmer's contact and the possibility of ingestion of water during the recreational activity. Furthermore, rating curves were established for pH, chemical oxygen demand, nitrate, phosphate, detergents, enterococci, total coliforms, faecal coliforms and Escherichia coli. RESULTS AND CONCLUSIONS: The index was applied to the data set on water quality of the Potrero de los Funes River (San Luis, Argentina), generated during 2 years (2009-2010). Following the RWQI values classification, most of the Potrero de los Funes water samples fell in the good quality range during the study period.

Evaluation of hybrid treatments to produce high quality reuse water.

Four tertiary hybrid treatments to produce high quality reused water, fulfilling Brazilian drinking water regulations, from a slaughterhouse's secondary treated effluent were evaluated. The pilot plant with a capacity of 500 L h(-1) was set up and consisted of these stages: pre-filtration system (cartridge filter 50 micron, activated carbon filter, cartridge filter 10 micron), oxidation (H2O2) or second filtration (ceramic filter, UF) followed by UV radiation (90 L h(-1)). The best combination was T4: pre-filtration followed by H2O2 addition and UV radiation (AOP H2O2/UV). Disinfection kinetics by T4 followed pseudo first-order kinetics: k(T4) = 0.00943 s(-1) or 0.00101 cm2 mJ(-1). Three different zones (A, B, C) were observed in the UV254 degradation kinetics (pseudo-first order kinetics): k' decreased over time (k'(A) > k'(B) > k'(C)).

[Microbiological evaluation of drinking water used in feeding units]. / Avaliação microbiológica da água de consumo empregada em unidades de alimentação.

The water for human consumption is the main vehicle for the transmission of pathogens that are capable of causing enteric parasitic diseases; therefore, its microbiological control is vital. This work had the purpose of evaluating the bacteriological quality of drinking water, in terms of the presence of total and thermotolerant coliforms, in different Feeding Units in the city of Recife, Pernambuco State, according to the potableness standards established by Ordinance No. 518 of 2004 of the Brazilian Ministry of Health/ANVISA. Forty water samples were collected in the Feeding Units located near the UFPE and UFRPE. The bacteriological tests for research on total and thermotolerant coliforms were carried out in accordance with the protocol of APHA (1995). Of the analyzed samples, 62.5% presented total coliforms and 42.5% thermotolerant coliforms. According to the results obtained, 62.5% of the samples are not in compliance with the law in force.

Avaliação microbiológica da água de consumo empregada em unidades de alimentação / Microbiological evaluation of drinking water used in feeding units

A água de consumo humano é o principal veículo de transmissão de patógenos capazes de causar infecções gastrointestinais, sendo vital o seu controle microbiológico. O presente trabalho teve a finalidade de avaliar a qualidade bacteriológica da água para o consumo humano, quanto à presença de coliformes totais e termotolerantes, em diferentes unidades de alimentação na cidade do Recife (PE), conforme os padrões de potabilidade estabelecidos pela Portaria nº 518 de 2004 do Ministério da Saúde/ANVISA. Foram coletadas quarenta amostras de água em unidades de alimentação, localizadas no entorno da Universidade Federal de Pernambuco e da Universidade Federal Rural de Pernambuco. Foram realizados os testes bacteriológicos para pesquisa de coliformes totais e termotolerantes, conforme o protocolo do APHA (1995). Das amostras analisadas, 62,5 por cento apresentaram coliformes totais e 42,5 por cento, coliformes termotolerantes. De acordo com os resultados obtidos, 62,5 por cento das amostras não estão em conformidade com a legislação vigente.

The water for human consumption is the main vehicle for the transmission of pathogens that are capable of causing enteric parasitic diseases; therefore, its microbiological control is vital. This work had the purpose of evaluating the bacteriological quality of drinking water, in terms of the presence of total and thermotolerant coliforms, in different Feeding Units in the city of Recife, Pernambuco State, according to the potableness standards established by Ordinance No. 518 of 2004 of the Brazilian Ministry of Health/ANVISA. Forty water samples were collected in the Feeding Units located near the UFPE and UFRPE. The bacteriological tests for research on total and thermotolerant coliforms were carried out in accordance with the protocol of APHA (1995). Of the analyzed samples, 62.5 percent presented total coliforms and 42.5 percent thermotolerant coliforms. According to the results obtained, 62.5 percent of the samples are not in compliance with the law in force

Users' perception as a tool to improve urban beach planning and management.

Four beaches that share physiographic characteristics (sandy, wide, and long) but differ in socioeconomic and cultural terms (three are located in northwestern Mexico and one in California, USA) were evaluated by beach users. Surveys (565) composed of 36 questions were handed out to beach users on weekends and holidays in 2005. The 25 questions that revealed the most information were selected by factor analysis and classified by cluster analysis. Beach users' preferences were assigned a value by comparing the present survey results with the characteristics of an "ideal" recreational urban beach. Cluster analysis separated three groups of questions: (a) services and infrastructure, (b) recreational activities, and (c) beach conditions. Cluster linkage distance (r=0.82, r=0.78, r=0.67) was used as a weight and multiplied by the value of beach descriptive factors. Mazatlán and Oceanside obtained the highest values because there are enough infrastructure and services; on the contrary, Ensenada and Rosarito were rated medium and low because infrastructure and services are lacking. The presently proposed method can contribute to improving current beach evaluations because the final score represents the beach users' evaluation of the quality of the beach. The weight considered in the present study marks the beach users' preferences among the studied beaches. Adding this weight to beach evaluation will contribute to more specific beach planning in which users' perception is considered.

Influence of urbanization and tourist activities on the water quality of the Potrero de los Funes River (San Luis - Argentina).

A study of the water quality of the Potrero de los Funes River (San Luis - Argentina) was carried out in order to evaluate the possible effect of the anthropogenic activities on the river developed in the homonymous town. Samples were collected during the period March 2000-November 2005 at three selected sampling sites (RP(1), RP(2) and RP(3)). Different physicochemical and bacteriological parameters (turbidity, pH, conductivity, suspended solids, alkalinity, potassium, sodium, calcium, magnesium, chlorides, nitrates, phosphates, sulphates, chemical oxygen demand (COD), 5-day biological oxygen demand (BOD(5)), dissolved oxygen, total coliforms, Escherichia coli and total heterotrophic bacteria) were analysed according to the Standard Method for the Examination of Water and Wastewater. When comparing the values of total coliforms, E. coli, total heterotrophic bacteria, COD, BOD(5) and phosphates from the zone without anthropogenic influence (RP(1)) and the urban zones (RP(2) and RP(3)) an important variation in the parameters was observed. These results indicate that the urban activity produces a serious and negative effect on the water quality, thus constituting a sanitary risk and may have a major impact on the trophic status of the Potrero de los Funes dam. As case study, we report on the use of General Quality Index (GQI) to evaluate spatial and seasonal changes in the water quality of Potrero de los Funes River. Results revealed a significant degradation of the water quality at RP(2) and RP(3).

Biofilms coating Schoenoplectus californicus as indicators of water quality in the Río de la Plata Estuary (Argentina).

Community composition, structure, biomass and tolerance to pollution of biofilms growing on Schoenoplectus californicus were assessed, together with physico-chemical parameters of the water, to evaluate their usefulness as water quality indicators along the Argentinian shore of the freshwater zone of the Río de la Plata Estuary. Monthly sampling was carried out at three sites, one of which, located in a nature reserve, was considered as the reference site while the others were affected by sewage outlets and port activity. The reference site had higher dissolved oxygen and turbidity values, the polluted sites greater conductivity, oxygen demands, phosphate, ammonium and nitrite values. Diatoms dominated the biofilms at the reference site; ciliates reached higher densities at the polluted sites. Significant differences were found in species numbers, species diversity index, biomass, tolerance to pollution of the taxa, and the Pampean Diatom Index, between the reference and the impacted sites. This study shows that the biofilms growing on Schoenoplectus californicus are good indicators of the changes in the water quality of their environment.

Influence of mining activities in the North of Potosi, Bolivia on the water quality of the Chayanta River, and its consequences.

Mining activity in the North of Potosi (Siglo XX mine, Ingenio Catavi-Siglo XX, Pucro mine and Colquechaca mine) produces minewater containing high concentrations of heavy metals such as As (0.02-34 mg/l), Cd (45-11,600 microg/l), Cu (0.35-32 mg/l), Fe (42-1,010 mg/l), Pb(33-3,130 microg/l), Ni(20-4,320 microg/l), and Zn (1.1-485 mg/l), that exceed considerably the limit values. The rivers in the North of Potosi (Katiri and Pongoma) that do not receive minewater contain clear water with rather low heavy metal concentrations. These rivers and also other rivers contaminated with minewater, are tributaries of the Chayanta River that transports water with a high concentration of heavy metals such as As (6-24 microg/l), Cd (260-2,620 microg/l), Cu (205-812 microg/l), Pb(10-21 microg/l) and Ni(110-332 microg/l). These elements result from mining activity, as indicated by a comparison with rivers not contaminated by minewater discharges. Water of the Chayanta River, used all year long by the population of Quila Quila, (a village situated at about 75 km from the mining centers), for the irrigation of crops such as potato, maize and broad bean, contains heavy metal concentrations exceeding for several elements the guidelines for irrigation. As drinking water the population of Quila Quila consumes spring water with a generally acceptable heavy metal concentration, as well as infiltrated water of Chayanta River (which is also used in animal drinking troughs) with a high concentration of Cd (23-63 microg/l), exceeding the limit value for drinking water. The metal concentration is significantly lower in the infiltrated water than in the water of Chayanta River. Some technological solutions are suggested to improve the quality of the water used. Surveys carried out on inhabitants of the region, showed that many people present health problems, probably to be attributed to the bad quality of the water they consume and use for irrigation.

Transportation of juvenile tambaqui (Colossoma macropomum) in a closed system.

The objective of this study was to investigate the effect of density, duration and the use of additives to the water during the transportation of juvenile tambaqui (Colossoma macropomum) and use of this data to establish a safe transportation protocol for the species. The tested products and dosages were: salt (1000, 2000 and 3000 mg/L), gypsum (100, 300 and 500 mg/L) and benzocaine (10, 20 and 30 mg/L). Fish were transported in closed systems (plastic bag) at different densities and time periods of up to 24 h. Fish survival (FS) and water quality parameters were monitored immediately after transportation. The remaining fish were kept in floating cages in order to evaluate mortality which occurred up to 96 h after transportation (S96). The best fish density, additives dosages and time period of the transportation was estimated with a general linear model. The effect of the condition factor on FS and S96 was also evaluated. As expected, FS and S96 were significantly related to time and density. FS but not S96, were also were significantly related to treatment. FS with gypsum treatment was not different from controls and FS with table salt and benzocaine treatments were significantly reduced. The condition factor was not related to either FS or S96. FS was inversely correlated with carbon dioxide concentration. It was concluded that the additives did not improve fish transportation survival. Linear models were developed to predict the best transportation densities as a function of time.

Transportation of juvenile tambaqui (Colossoma macropomum) in a closed system

O objetivo deste estudo foi investigar o efeito da densidade, duração e do uso de aditivos na água durante o transporte de juvenis de tambaqui (Colossoma macropomum) e usar estes resultados para estabelecer um protocolo seguro de transporte para esta espécie. Os produtos testados e suas doses foram: sal de mesa (1000, 2000 e 3000 mg/L), gesso (100, 300 e 500 mg/L) e benzocaína (10, 20 e 30 mg/L). Os peixes foram transportados em sistema fechado (saco plástico) em diferentes densidades e por diferentes tempos por até 24 h de transporte. A sobrevivência e os parâmetros de qualidade da água foram monitorados imediatamente após o transporte. Os peixes que sobreviveram ao transporte foram colocados em tanques-rede para avaliar a mortalidade após 96 h. A melhor densidade, tempo de transporte e aditivo foram estimados por modelo linear geral. O efeito do fator de condição na sobrevivência após o transporte e na sobrevivência de 96 h também foi avaliado. Como esperado, a sobrevivência após o transporte e a sobrevivência de 96 h foram significativamente correlacionados com o tempo e a densidade. A sobrevivência após o transporte, mas não a sobrevivência de 96 h, também tem correlação com os aditivos testados. A sobrevivência após o transporte é significativamente igual para o tratamento controle e para os tratamentos que receberam gesso e significativamente menor para os tratamentos que receberam sal e benzocaína. O fator de condição não tem correlação com a sobrevivência após o transporte e a sobrevivência de 96 h. É conclusivo que os aditivos testados não melhoram a sobrevivência de juvenis de tambaqui após o transporte. Modelos lineares foram desenvolvidos para predizer a melhor densidade de transporte em função do tempo.

Microbial quality of domestic and imported brands of bottled water in Trinidad.

A cross-sectional study was conducted to determine the microbial quality of domestic and imported brands of bottled water available in Trinidad, purchased from six geographical regions in Trinidad, and representing the whole island. A sample size of 344 bottles of water was determined by using a precision rate of 2% and a Type 1 error of 5%. The membrane filter technique was used with cultures grown on m-Endo agar and m-FC agar for total coliforms and thermotolerant coliforms, respectively. Aerobic plate count (APC) was determined on nutrient agar; Pseudomonas aeruginosa was detected on MacConkey agar, Escherichia coli was isolated on eosin methylene blue (EMB) and Salmonella spp. was assayed by using standard methods. Of the 344 water samples tested, 262 (76.2%) and 82 (23.8%) were domestic and imported brands, respectively. Eighteen (5.2%) of the 344 samples contained coliforms with a mean count of 0.88+/-6.38 coliforms per 100 ml, while 5 (1.5%) samples contained E. coli. The prevalence of total coliforms in domestic brands of bottled water was 6.9% (18 of 262) as compared with 0.0% (0 of 82) detected in imported brands. The difference was statistically significant (p=0.004). Similarly, the prevalence of aerobic bacteria in domestic brands of bottled water (33.6%) was significantly higher (p=0.001) than was found in imported brands (14.8%). Twenty-six (7.6%) of the total samples of water contained Pseudomonas species, but all were negative for thermotolerant coliforms and Salmonella spp. It was concluded that based on the recommended zero tolerance for coliforms in potable water, 5% of bottled water sold in Trinidad could be considered unfit for human consumption.

Coordinadora interinstitucional UNDESCOM-VMSB

La consultoría de referencia es un esfuerzo de apoyo conjunto de Banco Interamericano de Desarrollo BID, Programa de agua y saneamiento (Banco Mundial), Cooperación Alemana GTZ y Organización Panamericana de la Salud OPS/OMS, al Viceministerio de Servicios Básicos a objeto de obtener un diagnóstico general del desempeño sectorial, intercambio de la información, de las experiencias para retroalimentar al sector. Recabar información para la elaboración del Plan Decenal de desarrollo comunitario, generar propuestas de modelos, estrategias y políticas. Los productos de la consultoría son: comentarios el impacto logrado por los diferentes proyectos, emitir recomendaciones a efectos de mejorar la aplicación de recursos en la solución de la problemática del sector, elaboración de la norma de desarrollo comunitario para el sector de saneamiento básico y un plan operativo para la formulación de las políticas del Plan de desarrollo comunitario que se tradujo en el diseño de un Programa estratégico de sostenibilidad