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Version 1
11. October 2023.
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by Rodriguez-Alvarez et al., 11. October, 2023

Long-Term Assessment of a Water Safety Plan (WSP) in Salta, Argentina

by Rodriguez-Alvarez et al., 11. October, 2023

The use of water safety plans (WSPs) has been recommended by the World Health Organization (WHO) since 2004 as a highly effective means of improving water safety management. Experience with the implementation of WSPs is increasing worldwide, but there is no unified or standardized methodology for how the verification of a WSP should be conducted. In this article, we present a thorough evaluation of a specific WSP five years after its initial implementation. We reviewed the risk assessment methodology used by a water utility in Salta, Argentina, and assessed the implementation of control measures. To objectively evaluate the effectiveness of the WSP, we evaluated water quality parameters and customer complaints using a time-series analysis. We show that although some control measures were implemented, and a reduction in risk values was observed, it was not possible to improve long-standing problems in the water supply of the city of Salta, such as the number of consumer complaints or high turbidity levels in the water during the rainy season. We discuss the role of rigorous scientific assessments and the importance of legislation and regulatory bodies in implementing the WSP.

Version 1
1. February 2011.
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by Frank Greaves and Claire Simmons , 01. February, 2011

Water Safety Plans for communities: guidance for adoption of water safety plans at community level

by Frank Greaves and Claire Simmons , 01. February, 2011

Numerous publications now exist on the formation and use of WSPs, but most of these focus on largerscale projects run by private or public utilities, commercial enterprises and international NGOs. Tearfund’s particular interest is in how WSPs can be understood and established by user communities which are faced with self-managing a water supply project to gain sustainable access to safe water quality. The guide is written chiefly for the use of a facilitator or facilitating body (eg the hygiene promoters or community mobilisers of a DMT or partner staff) to use in training community members, and in particular,the water project accountability group (eg Water Users Committee) of the community.

Version 0
19. May 2016.
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by Luca Lucentini et al., 2014

Linee guida per la valutazione e gestione del rischio nella filiera delle acque destinate al consumo umano secondo il modello dei Water Safety Plans .

by Luca Lucentini et al., 2014

One decade ago, the World Health Organization recommended that water suppliers developed and implemented Water Safety Plans (WSP) as the most
effective mean to assure the quality of the water supply and the protection of the health of consumers. This model, as transposed in this guideline, consists of the overall risk assessment and risk management from catchment to tap, to protect the water to be destined to human consumption and the system, as well
as to control any process potentially affecting water quality, with the aim of assuring on a continuous way the absence of physical, biological and chemical hazards in drinking water. Risk based approach will also facilitate the flexibility of hazards management of emerging contaminants which are not systematically monitored, and /or vulnerabilities of water supply systems to direct and indirect impacts due to climate change. The guidance is addressed to water suppliers and health authorities as well as to all the stakeholders interested in different way to the drinking water quality. Criteria, methods and procedures are here provided in clear and practical terms to develop and implement WSP in drinking water supplies in Italy, independently by their dimension and by the volumes of supplied water.

Version 1
19. May 2016.
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by Marilyn Maycock USEPA, 19. May, 2016

ppt – Quality Systems: ISO/IEC 17025:2005

by Marilyn Maycock USEPA, 19. May, 2016

Powerpoint presentation for the US EPA with an introduction to the ISO ISO/IEC 17025:2005 international standard for calibration and testing labs - including its purpose and how to ensure the quality system are effective

Version 1
1. November 2011.
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by World Health Organization et al., 01. November, 2011

Vietnam: Water safety plan

by World Health Organization et al., 01. November, 2011

Under AusAid funding, WHO supported WSP implementation in Vietnam. This case study highlights key WSP facts, and describes the water supply situation and regulation of WSP in Vietnam

Version 4
21. April 2016.
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by WHO, 2011

Guidelines for drinking-water quality (4th Ed. incorporating the first addendum) – ENGLISH

by WHO, 2011

The Guidelines for drinking-water quality is an authoritative basis for the setting of national regulations and standards for water safety in support of public health. It provides guidance on ways of implementing its recommendations of contextual hazard identification and risk management, including catchment-to-consumer water safety plans. The Guidelines position WSPs as a core element of the Framework for Safe Drinking-water and outline the principles and key elements of a WSP for policy-makers.

Version 2
11. July 2017.
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by Karen Setty et al., 19. February, 2017

Water quality, compliance, and health outcomes among utilities implementing Water Safety Plans in France and Spain

by Karen Setty et al., 19. February, 2017

Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240K manual samples and 1.2M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher’s exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes.
(Final report at https://doi.org/10.1016/j.ijheh.2017.02.004)

Version 2
21. April 2016.
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by WHO, 1997

Guidelines for Drinking-Water Quality (2nd Ed. Volume 3 – Surveillance and control of community supplies

by WHO, 1997

This publication describes the methods used in the surveillance of drinking-water quality in the light of the special problems of small-community supplies, particularly in developing countries, and outlines the strategies necessary to ensure that surveillance is effective. It is also concerned with the linkage between surveillance and remedial action and with the form that remedial action should take.

Version 1
7. January 2020.
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by Isabelle Schmidt et al., 30. October, 2019

Implementation and evaluation of the water safety plan approach for buildings

by Isabelle Schmidt et al., 30. October, 2019

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.

Version 1
28. February 2017.
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by Ministry of Water Irrigation and Energy Federal Democratic Republic of Ethiopia, 01. July, 2015

CLIMATE RESILIENT WATER SAFETY PLAN IMPLEMENTATION – Guidelines for Community Managed Rural Drinking Water Supplies

by Ministry of Water Irrigation and Energy Federal Democratic Republic of Ethiopia, 01. July, 2015

The purpose of these Ethiopian guidelines is to provide step-by-step guidance to the rural community/board managed water supplies on how to develop, implement, monitor, and review the rural community managed water safety plans aimed at protecting human health. Furthermore, it serves as a practical tool in identifying and addressing priority risks to the water quality and quantity, reliability and sustainability of the rural water supply system including risks related to current and future impacts of climate changes by taking into consideration available resources and capacities of the water supply system.

Version 1
19. May 2016.
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by Angella Rinehold, 25. August, 2016

Rural WSP template for Cambodia

by Angella Rinehold, 25. August, 2016

This resource provides a template for a WSP for a rural community in Cambodia which has been customized and tailored to the local context through a pilot programme.
Important note - This template should be adapted and trialed before being used in a different context.

Version 4
24. August 2016.
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by WHO, 2011

Guidelines for drinking-water quality (4th Ed.) – CHINESE

by WHO, 2011

The Guidelines for drinking-water quality is an authoritative basis for the setting of national regulations and standards for water safety in support of public health. It provides guidance on ways of implementing its recommendations of contextual hazard identification and risk management, including catchment-to-consumer water safety plans.

Version 2
29. July 2016.
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by WHO, 29. July, 2013

WSP implementation and lessons learned: Amarapuri Water Supply

by WHO, 29. July, 2013

This case study describes the benefits, challenges, and lessons learned from WSP implementation in the Amarapuri Water Supply System, Nepal.

Version 1
21. February 2017.
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by Oliver Schmoll et al., 01. June, 2014

Das Water-Safety-Plan-Konzept: Ein Handbuch für kleine Wasserversorgungen (The WSP concept: a manual for small water supplies)

by Oliver Schmoll et al., 01. June, 2014

The German Environment Agency and the Water Technology Centre published a manual for implementation of the WSP approach in small-scale water supplies in Germany in 2014, which complements the technical rule on WSPs of the German Technical and Scientific Association for Gas and Water (DVGW) with practical explanations, recommendations, examples and supporting tools.

Version 1
19. October 2022.
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14. January, 2022

OPERATIONAL POLICY AND GUIDING DOCUMENT. GWCL

14. January, 2022
Version 0
21. February 2019.
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by Karen Setty et al., 20. February, 2019

Comparative evaluation of risk management frameworks for U.S. source waters

by Karen Setty et al., 20. February, 2019

The U.S. Safe Drinking Water Act required states to develop source water assessment programs identifying existing and potential contamination sources; however, comprehensive risk prioritization and management approaches for surface water supplies have seen limited application. This participatory study assessed which permutation(s) of risk management frameworks and tools might benefit U.S. utilities by combining a literature review with external utility interviews. Qualitative data provided a basis for categorical assignments of goodness of fit
with each of 24 framework evaluation criteria across five categories. Weighted integration using stakeholder input provided a relative ranking of applicability, later validated at a decision-making workshop. Hybridization of the American National Standards Institute/American Water Works Association (ANSI/AWWA G300) source water protection standard and World Health Organization Water Safety Plan guidance was recommended to develop a comprehensive risk management approach for U.S. source waters. Cost–benefit components of other guidance materials were recommended to incorporate financial considerations into risk ranking and mitigation decisions.

Version 1
4. December 2020.
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Water Safety Planning (WSP), an approach which aims at ensuring safe drinking-water thorough a comprehensive risk system assessment and management process since its adoption by the International Water Association (IWA) and World Health Organization (WHO) seeks to support achieving the Sustainable Development Goal (SDG) target 6.1 to provide safe drinking-water for all.
Since  its adoption,  national governments have included them in national legislation to promote their implementation because of its immense benefits.

In scaling up effective up of WSP implementation across these different countries, this worldwide accepted approach needs to be supported by tools, resources, regulations and policies, guidelines to create the enabling environment and support stakeholder participation at the national level.

IWA with support from OPEC Fund for International Development (OFID), under the Climate Resilient Water Safety Planning Project has produced this document with a summary of existing national policy and guidelines to support WSP implementation.

Version 1
19. February 2019.
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by Giuliana Ferrero et al., 31. January, 2019

Capacity building and training approaches for water safety plans: A comprehensive literature review.

by Giuliana Ferrero et al., 31. January, 2019

The World Health Organization has recommended Water Safety Plans (WSPs), a holistic risk assessment and risk management approach, for drinking-water suppliers across low-, middle- and high-income countries, since publishing its 2004 Guidelines for Drinking-Water Quality. While rapid WSP adoption has occurred, capacity is still catching up to implementation needs. Many countries and regions lack case examples, legal requirements, and training resources for WSPs, corresponding to widespread capacity shortfall in the water supply sector. We undertook a comprehensive review of the literature on capacity building and training for WSPs, with the goal of providing recommendations for multiple stakeholder groups at the scales of individual utilities, national governments, and intermediate units of governance. We propose a WSP training taxonomy and discuss it in relation to the stages of learning (introduction, practice, and reinforcement); describe the importance of customizing training to the target group, local language and circumstances; highlight the relevance of auditing for evaluating change over time; and call for robust methods to monitor WSP capacity development.

Version 1
25. May 2016.
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by Dani J. Barrington et al.,

How to prepare Water Safety Plans for community-managed water supply systems in rural Nepal – Nepali

by Dani J. Barrington et al.,

This package has been developed for WaSH practitioners seeking to develop water (probably more correctly, WaSH) safety plans with rural communities who manage their own water and sanitation systems. Although the overall guide is in English, all of the resources to be used with the community are in Nepali.

Version 1
8. November 2016.
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by World Health Organization (Editors: Rickert B et al., 01. July, 2016

Protecting surface water for health

by World Health Organization (Editors: Rickert B et al., 01. July, 2016

Protecting surface water for health provides a structured approach to understanding surface waters and their catchments to support the identification, assessment and prioritization of the risks, and the development of management strategies for their control, as a basis for providing safe drinking-water.

The book provides guidance and supporting information on the development and application of water safety plans, which represent best practice to address the assessment and control of surface-water hazards in drinking-water catchments.

Version 1
1. August 2009.
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by Peter Thompson and Sameera Majam , 01. August, 2009

The development of a generic Water Safety Plan for small community water supply

by Peter Thompson and Sameera Majam , 01. August, 2009

This case study describes the development of Water Safety Plans in small community water supplies in South Africa. It describes the previous assessment methods as well as the eleven steps taken to develop and implement the WSP.

Version 1
21. June 2017.
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by World Health Organization, 13. June, 2017

Global status report on water safety plans: A review of proactive risk assessment and risk management practices to ensure the safety of drinking-water

by World Health Organization, 13. June, 2017

Based on information gathered from 118 countries representing every region of the globe, this report provides a picture of WSP uptake worldwide. It presents information on WSP implementation and the integration of WSPs into the policy environment. It also explores WSP benefits, challenges and future priorities.

It is envisaged that this report will serve as a useful resource for policy-makers, practitioners and other stakeholders to inform and strengthen the planning and practice of WSP implementation.

Version 1
1. August 2009.
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by Peter Thompson and Sameera Majam , 01. August, 2009

South Africa The development of a generic water safety plan for small community water supply

by Peter Thompson and Sameera Majam , 01. August, 2009

This document describes development of a Water Safety Plan with a background focus on Africa.

Version 1
19. May 2016.
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by Royal Government of Bhutan et al., 01. December, 2013

Rural Water Safety Plan (RWSP) Facilitator’s Guide

by Royal Government of Bhutan et al., 01. December, 2013

The facilitator‟s guide for the Rural Water Safety Plan Workshop has been prepared based on the Water Safety Planning for Small Community Water Supplies adapted to the Bhutanese context. This manual will describe how rural communities can deliver and sustain safe drinking water by developing and implementing WSPs for their own communities.

Version 1
17. May 2016.
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by Maria J. Gunnarsdottir et al., 07. June, 2012

Benefits of Water Safety Plans: Microbiology, Compliance, and Public Health

by Maria J. Gunnarsdottir et al., 07. June, 2012

The article describes an Icelandic study to determine the impact of WSP implementation on regulatory compliance, microbiological water quality, and incidence of clinical cases of diarrhea.

Version 1
15. September 2021.
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by By Kizito Masinde; Michael Rouse; Martha Jepkirui; Katharine Cross, 01. April, 2021

Guidance on Preparing Water Service Delivery Plans: A manual for small to medium-sized water utilities in Africa and similar settings

by By Kizito Masinde; Michael Rouse; Martha Jepkirui; Katharine Cross, 01. April, 2021

This publication is a guideline or how-to manual on preparing water service delivery plans with a focus on small to medium sized organised water utilities having with approximately 5,000 to over 100,000 connections mainly in areas with limited capacity and resources. The manual is simplified enough to ensure that these utilities are able to move from a situation where they are struggling to deliver water services to where basic service levels in terms of water quality, quantity, accessibility, reliability, affordability, and acceptability are met. Meeting these basic service levels provides a strong foundation for the utility to progressively move up the ladder of delivering improved services.

Access the publication on IWAP.

Version 1
13. May 2016.
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by GRAHAM GAGNON et al., 2015

DRINKING WATER SAFETY PLANS

by GRAHAM GAGNON et al., 2015

The objective of this research was to understand the impact of WSPs on operators and water management culture in Alberta’s small communities.

Version 1
9. February 2023.
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by WHO et al., 23. January, 2023

WSP Manual: Module 3 supplementary tool – possible threats to the supply of safe drinking-water

by WHO et al., 23. January, 2023

This tool is intended to support the practical application of the guidance presented in the Water safety plan manual: step-by-step risk management for drinking-water suppliers, second edition (WHO & IWA, 2023). Refer to Module 3 in the manual for detailed guidance.

WSP teams can use this tool to help identify possible threats to water safety, which will inform the identification of hazards and hazardous events (Module 3).

Version 1
1. April 2012.
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by Unathi Jack and Philip de Souza , 01. April, 2012

Guidelines for using Web-Enabled Water Safety Plan Tool

by Unathi Jack and Philip de Souza , 01. April, 2012

The Water Research Commission (WRC) project K5/1993//3 “Web enablement of a water safety plan and incorporation of existing similar supply system assessment tool” aimed to establish a methodology to identify and manage the risks of water services infrastructure and the means by which Water Services Institutions (WSIs) are better able to identify and manage these through use of Water Safety Planning. The tool assists in developing a Water Safety Plan. Implementation thereof (e.g. taking required actions, implementing corrective actions, developing and implementing management and communication procedures) of the Water Safety Plan depends on the Water Services Institution (WSI).

Version 1
19. May 2016.
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by Mark Rodgers - USEPA, 19. May, 2016

ppt – The Importance of Laboratory Support in the Implementation of Water Safety Plans

by Mark Rodgers - USEPA, 19. May, 2016

Powerpoint presentation from the USEPA on the Importance of Laboratory Support in the Implementation of Water Safety Plans. The critical elements to laboratory support as well as he linkages between Water Safety Plan implementation and laboratory support are explained.

Version 1
1. October 2008.
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by WHO - Western Pacific Region , 01. October, 2008

Training workbook on Water Safety Planning Urban systems

by WHO - Western Pacific Region , 01. October, 2008

The objective of this workbook is to serve as a guide to facilitate WSP development for an organised water supply that is managed by a water utility or similar entity. WSPs can be tailored differently for each specific water supply system. This workbook is generic and is not specific to any particular country. It is anticipated that trainers in each country would develop their own WSP training material which would be linked directly to country drinking water standards and implementing guidelines as well as bring written in other appropriate languages.

Version 2
1. November 2011.
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by Enviromental Health Control Section et al., 01. November, 2011

Water Safety Plan Handbook: for rural water supply systems

by Enviromental Health Control Section et al., 01. November, 2011

Provides customized guidance on implementing WSPs in rural water supply systems tailored to the Malaysian context

Version 1
22. March 2010.
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by AusAID and SOPAC , 22. March, 2010

Drinking Water Safety Planning: A practical guide for the Pacific Island countries

by AusAID and SOPAC , 22. March, 2010

This document is a guideline for development and implementation of Water Safety Plans approach in the Pacific. It is primarily for water supply managers, engineers and operators and introduces a more proactive way of managing drinking water supplies through a comprehensive risk assessment and risk management approach. Implementing DWSPs helps achieve a more effective drinking water supply system.

Version 1
8. November 2016.
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by World Health Organization (Editors: Rickert B et al.,

Protecting surface water for health: Editable checklists and tables to support catchment inspection

by World Health Organization (Editors: Rickert B et al.,

Protecting surface water for health provides a structured approach to understanding surface waters and their catchments to support the identification, assessment and prioritization of the risks, and the development of management strategies for their control, as a basis for providing safe drinking-water.

Editable versions of the catchment and pollution assessment checklists and inventory tables that are presented in the book to support surface-water catchment inspection are presented here. Please refer to the introductory pages of Section 3.2 of Protecting surface water for health for guidance on how to use these checklists and tables to perform a catchment assessment (http://www.who.int/water_sanitation_health/publications/pswh/en/).

Version 1
5. March 2020.
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by University of Surrey, 05. March, 2020

Risk assessment of small water supplies

by University of Surrey, 05. March, 2020

Set in Iceland, this short video documents how sanitary inspections can be applied as a basic risk management tool for small water supplies. For more information, visit: https://www.surrey.ac.uk/department-civil-environmental-engineering/research/water-environment-and-health-engineering-group

Version 1
19. July 2016.
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by Nguyen Lanh et al., 19. July, 2016

GUIDELINES ON WATER SAFETY INVESTMENT PLAN (WSIP) FOR APPLICATION IN IMPLEMENTATION OF WATER SAFETY PLAN PHASE 3 IN VIETNAM

by Nguyen Lanh et al., 19. July, 2016

Water supply companies may face challenges when developing an investment plan for implementation of WSPs, due to the relatively large number of objectives with limited available budget for funding. This draft publication aims to provide guidance for water service companies to develop an investment plan that can meet the most of basic requirements of a WSP in a most cost-effective manner.
This draft publication is currently under review, and we would welcome your feedback to WSPortal@iwahq.org.

Version 1
3. January 2017.
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by Ahmad Montazeri, 13. September, 2015

Development and implementation of water safety plans in Iran

by Ahmad Montazeri, 13. September, 2015

This presentation describes the development and implementation of WSP in Tabriz in Iran under the guidance of the World Health Organization Regional Office.

Version 1
7. June 2016.
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by Luca Rondi et al., 14. August, 2015

Sustainability of Water Safety Plans Developed in Sub-Saharan Africa

by Luca Rondi et al., 14. August, 2015

The WSP approach was elaborated within two cooperation projects implemented in rural areas of Burkina Faso and Senegal by two Italian NGOs (Non-Governmental Organisations). In order to evaluate its sustainability, a questionnaire based on five different sustainability elements and a cost and time consumption evaluation were carried out and applied in both the case studies. Results demonstrated that the questionnaire can provide a useful and interesting overview regarding the sustainability of the WSP; however, further surveys in the field are recommended for gathering more information. Time and costs related to the WSP elaboration, implementation, and management were demonstrated not to be negligible and above all strongly dependent on water quality and the water supply system complexity.

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8. November 2018.
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by Antonios Papadakis et al., 26. March, 2018

Legionella spp. Risk Assessment in Recreational and Garden Areas of Hotels

by Antonios Papadakis et al., 26. March, 2018

Several Travel-associated Legionnaires’ disease (TALD) cases occur annually in Europe. Except from the most obvious sites (cooling towers and hot water systems), infections can also be associated with recreational, water feature, and garden areas of hotels. This argument is of great interest to better comprehend the colonization and to calculate the risk to human health of these sites. From July 2000–November 2017, the public health authorities of the Island of Crete (Greece) inspected 119 hotels associated with TALD, as reported through the European Legionnaires’ Disease Surveillance Network. Five hundred and eighteen samples were collected from decorative fountain ponds, showers near pools and spas, swimming pools, spa pools, garden sprinklers, drip irrigation systems (reclaimed water) and soil. Of those, 67 (12.93%), originating from 43 (35.83%) hotels, tested positive for Legionella (Legionella pneumophila serogroups 1, 2, 3, 6, 7, 8, 13, 14, 15 and non-pneumophila species (L. anisa, L. erythra, L. taurinensis, L. birminghamensis, L. rubrilucens). A Relative Risk (R.R.) > 1 (p < 0.0001) was calculated for chlorine concentrations of less than 0.2 mg/L (R.R.: 54.78), star classification (<4) (R.R.: 4.75) and absence of Water Safety Plan implementation (R.R.: 3.96). High risk (≥104 CFU/L) was estimated for pool showers (16.42%), garden sprinklers (7.46%) and pool water (5.97%).

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31. July 2017.
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by WECF International, 30. June, 2017

WSSP compendium – Developing a water & sanitation safety plan in a rural community

by WECF International, 30. June, 2017

A Water and Sanitation Safety Plan (WSSP) is an efficient methodology to manage drinking water and sanitation safely and is based on the Water Safety Plan and Sanitation Safety Plan approach by WHO. This WSSP Compendium aims to enable communities to develop a WSSP for small-scale water supplies, e.g. dug wells, boreholes, springs and piped centralised water supply systems, and as well as to assess the quality of sanitation facilities such as school toilets.