Global clinical immersion for primary care training: Learning from the global community

Abstract

Background: Efforts to implement village-level water, sanitation, and hygiene (WaSH) projects often suffer challenges related to appropriate technology, local availability of supplies, and sufficient training and equipping of the implementation team. This study highlights lessons learned from a safe drinking water treatment and storage project undertaken through a community-based participatory research collaboration in rural Punjab, India. Partners include a communitybased organization, nine villages, and both a U.S. and Indian public health academic program. A safe water treatment and storage pilot project was initiated in four of the nine villages in Spring 2013. Three project activities were evaluated including the installation of custommade containers in 180 homes with a piped water supply, the identification of stand-alone and affordable drinking water containers for low-income households without a tap, and point-of-use chlorine treatment and awareness. Structure/Method/Design: Sixty-seven of the custom-made containers were evaluated for technical merits using a checklist. A questionnaire was developed to assess user satisfaction. Market research was conducted to assess container preferences, availability, and affordability for families without a tap. Last, point-of-use chlorine treatment awareness was assessed for all types of containers. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Mehar Baba Charitable Trust, Post Graduate Institute Summary/Conclusion: Community demand for a safer and more convenient way to store water was evident. Performance of the custom containers was mixed and design and implementation problems included nonsealing lids, leaky spouts, difficult to clean, and proper placement. An external problem included low water pressure resulting in low flow and difficulty in tracking flow, which is required for proper chlorination. Appropriate stand-alone containers were identified in the local market for 250 to 650 rupees. Willingness to chlorinate was high and “keeping children healthy” was an effective educational message. Chlorine tablets were only available in bulk, making it difficult to procure for home use. The team repackaged chlorine tablets for more effective household distribution. Educational materials for point-of-use chlorination were also developed. New water container designs should be fully vetted before widespread implementation, demand for WaSH is increasing due to promotional efforts, and a new way to treat drinking water with chlorine is more acceptable than previously thought.