Water Institute Three Year Review

Page 1

The Water Institute at UNC Three Year Review: 2010 –11 to 2012–13

Thank You W e wo u l d l i k e to t h a n k the following organizations and individuals for their generous contributions and support to The Water Institute.

P r oj e ct S p o ns o r s : Adam Smith International Alaska Native Tribal Health Consortium Bill and Melinda Gates Foundation Conrad N. Hilton Foundation Department for Environment, Food and Rural Affairs (UK) Health Canada IAPMO International Water and Sanitation Centre International Water Association International Water Centre Michael and Susan Dell Foundation Millennium Water Alliance National Environmental Health Association National Institutes of Health Fogarty International Center North Carolina Sea Grant P&G Children’s Safe Drinking Water Program PATH Plan International USA Robert Wood Johnson Foundation TK Holdings, Inc. UNEP Risoe Centre UNESCO UNICEF University of Bristol (UK) University of Leeds (UK) UNU-WIDER US EPA US EPA—People, Prosperity and Planet Program USAID Wallace Genetic Foundation WASRAG WaterAid Wells Fargo Foundation WHO World Bank World Vision

C o n f e r e nc e S p o ns o r s : 300in6 American Water Works Association Amway Aquagenex Aquatest /University of Bristol (UK) Catholic Relief Services Collegiate Capital Management Conrad N. Hilton Foundation Environmental Science and Technology Journal FHI 360 IAPMO Neerman NSF International Pall Medical Pfizer Plan International USA Profile Products RTI International Sensus Suez Environment/United Water TK Holdings, Inc. Tomlinson Industries Triangle Global Health Consortium Triple Quest Vestergaard Frandsen/LifeStraw Wells Fargo Foundation I n d i v i d ua l C o nt r i b uti o ns : Marcia Angle and Mark Trustin Carol and Michael Baum John McConnell Stephen Morse Mary Norris Preyer Oglesby Amy Thorne Pitt Perialwar Regunathan The Haiti Connection Chen-yu Yen S p e ci a l T h a n k s to : Don and Jennifer Holzworth

Contents 4 5 6 7 8 10 12 14 16 18 19 20 22 24 26 28 35 39

Message from the Dean Message from the Director Strategic Functions Focus Areas Monitoring, Evaluation and Learning for WaSH WaSH Governance Sanitation for the 21st Century Adapting to Water Scarcity and Climate Change Drinking Water for All National and Regional WaSH Challenges in the US Water-Food-Climate-Energy Nexus Research Knowledge and Information Management Networking and Partnerships Teaching and Learning Who We Are Publications Finances

A B B r e v i At i o n s CDC

Centers for Disease Control and Prevention


Community-led Total Sanitation


Department for International Development (UK)


Department for Environment, Food and Rural Affairs (UK)


Global Environment Facility


household water treatment and safe storage

d e s i g n : UNC Creative


International Association of Plumbing and Mechanical Officials

All photos in the report are courtesy of


International Water Association

UNC Gillings School of Global Public


Joint Monitoring Programme for Water Supply and Sanitation

Health, with thanks to Lisa Albert, Tom

(of WHO and UNICEF)

Fuldner Photography, Barbara Tyroler,


Millennium Development Goal

Dan Powell, The Water Institute and other


monitoring, evaluation and learning

photographers as highlighted.


nongovernmental organization


National Institutes of Health (US)

Water Institute faculty, staff and students


open-defecation free

contributed to the text of this report.


Program for Appropriate Technology in Health

Angie Brammer served as our copy editor.


Sanitation and Water for All Partnership


United Nations


United Nations Children’s Fund


United Nations Environment Program


University of North Carolina at Chapel Hill


US Environmental Protection Agency


US Water Partnership


virtual learning center


water, sanitation and hygiene


World Health Organization


Water Safety Plan


World Water Development Report

ŠThe University of North Carolina at Chapel Hill




The Water Institute at UNC Development

Water at UNC Message from Barbara K. Rimer, DrPH d e A n o f u n c g i l l i n g s s c h o o l o f g l o B A l P u B l i c h e A lt h



ince the earliest days of this School, our faculty and students have been leaders and innovators in solving problems of water, sanitation and hygiene (WaSH). They have worked on access, delivery, testing and policy. They have created solutions in North Carolina, across the US and around the world. We have been at this work for a long time, because WaSH problems are huge global and local issues that have challenged, daunted and stymied some of the smartest people in the world. In a time when we can put men and women in space and sequence the human genome, why can’t we ensure every human on the planet has access to safe water and sanitation? Why do we need Millennium Development Goals to push us to do better? Because even though water is essential to life, we still have not assured that it is available to each life. Impatient with the pace of progress so far, we launched The Water Institute in 2010. We knew that Jamie Bartram, PhD, former head of Water and Sanitation at the World Health Organization, also was impatient for progress, and that he would be challenged, but undaunted, by the enormity of the global problem—at least 1.8 billion people in the world today without safe water and 2.5 billion without access to basic sanitation. We were confident that he would create the interdisciplinary environment needed for innovations in problem solving, and that, as part of such an effort, he would bring together smart people from different fields, all committed to the goal of safe water and sanitation for all. And he has done that. For three years, the Institute has hosted the Water and Health Conference, which convenes international researchers, practitioners, policy-makers, students and entrepreneurs focused on the intersections of water, sanitation, hygiene, health and development. It’s one of the most stimulating, energizing and exciting meetings anywhere. This three year review highlights The Water Institute’s evolution into a US leader on the links between WaSH, health and development. The Institute, through its strategic collaborations with partners in science, academia, the private sector intergovernmental organizations and nongovernmental organizations as well as local governments in developed and developing nations, is making a positive impact on our campus and around the world. Thanks to the efforts of Professor Bartram and others, in 2012 UNC leaders announced that Water In Our World would be the university’s first campus theme. Since then, ideas and events have flowed across the campus, creating new interdisciplinary courses, events and research efforts. Water Institute faculty members and students also have completed influential research. Particularly notable was the development of a country-level, and also a US county-level, ranking of vulnerability to extreme weather events associated with climate change, and estimations that progress towards the MDG target has been over-stated for both water and sanitation. I am delighted with the Institute’s progress so far, as well as its future trajectory. This growth would not have been possible without the generous contributions made to further the Institute’s work. I am especially grateful for the Don and Jennifer Holzworth Distinguished Professorship Fund, which strengthens the School’s capacity to make a real difference in global health through The Water Institute. Our School’s Advisory Council (which Don Holzworth chairs) has been a source of generous financial support and great feedback and ideas. We are also grateful for the support we received from former Chancellor Holden Thorp. It is fitting that new UNC Chancellor Folt is known internationally as an environmental scientist who has focused on water. Water is fundamental to life and hope; it is everyone’s issue, and it is one to which I and our School are committed.

The Water Institute at UNC Message from Jamie Bartram, PhD director


ater is a defining challenge of the 21st century. It represents one of the great development opportunities of our time, impacting health, agriculture, security, the economy and the environment. Water will either constrain or enable the future development of every country, including the US. It will determine our prosperity, health and ability to enjoy nature; those countries that know how to manage water well have healthier and wealthier populations. The water, sanitation and hygiene challenges that confront North Carolina, the US and the world, demand interdisciplinary initiatives to deliver proven solutions supported by: financial innovation in managing water supplies; technological innovation in augmenting water resources; scientific innovation in understanding health and ecosystem impacts of new contaminants; social innovation in bringing water and sanitation to the unserved; and policy innovation to address threats such as climate change. We need a unified vision and cooperation to solve WaSH challenges. They call for academic leadership. UNC is well positioned to contribute to and advance the course of development in the coming decades. The University is responding to local, national and global water challenges by developing new courses with collaboration across disciplines and schools, expanding interdisciplinary research initiatives, and extending the campus theme, Water In Our World, until 2015. The Water Institute furthers this progress by addressing WaSH, health and development issues through our research, networking and partnership development, knowledge and information management, and teaching efforts. This review summarizes our work over the first three years –towards a world in which WaSH supports health and development for all.

THREE YEAR REVIEW: 2010–11 TO 2012–13

the mission of the water institute at unc is to provide global academic leadership for economically, environmentally, socially and technically sustainable management of water, sanitation and hygiene for equitable health and human development.


Strategic Functions Ou r st r at e g ic p l a n fo cus e s o n four key functions to support our mission to provide global academic leadership in WaSH, health and development, using science to inform good practices and appropriate policy, through forward-thinking, collaborative activities.


k nowl ed g e and in formation manag ement

global acade mic le ade r ship

n e two r kin g a n d partne r s h ip de v e lo p me nt

t e ac h in g and le ar nin g

R e s e a r c h : We provide leadership and direction in tackling critical knowledge gaps that hamper progress in water, sanitation, hygiene, health and development. Our research contributes to evidence-based decisions in the scientific, policy and practitioner communities domestically and internationally. In our first three years, we published more than 60 scientific papers, and citations of our work are increasing.

T he W ater I nstitute at U N C


Kn ow l e d g e a n d I n f o r m ati o n M a n ag e m e nt: We aim to provide balanced, objective and relevant information on WaSH, health and development for policy-makers, practitioners, researchers and funders. We use a range of channels in disseminating information, including WaSH publications, invited presentations, virtual learning opportunities, workshops, and our newsletter that reaches more than 15,000 individuals. We also co-publish with IWA the already well-established Journal of Water Sanitation and Hygiene for Development.

N e two r k in g a n d Pa rtn e r s h ip D e v e lo p m e nt: We bring together individuals and institutions from diverse disciplines and sectors, empowering them to collaborate to solve critical global issues in WaSH, health and development. Our annual Water and Health Conference attracts hundreds of participants from dozens of countries and organizations and we are launching two new conferences in 2014: Nexus 2014: Water, Food, Climate and Energy and Water Microbiology: Microbial Contaminants from Watersheds to Human Exposure. T e ac h in g a n d L e a r nin g : We use innovative distance learning programs and hands-on learning to help fill the global need for relevant, accessible training for WaSH professionals. Through multidisciplinary coursework, students benefit from the comparative advantage in the knowledge base and expertise of Water Institute faculty, staff, fellow students and collaborators. Our first distance learning program on Water Safety Plans is now a regular offering.

Ou r f i ve e sta bl is he d fo cus a r e as are things we see as the ‘elephants in the room’—the complex issues that are too readily ignored in favor of easier-to-answer questions, but that block accelerating and sustaining progress on WaSH. We aim to work with existing and new partners to identify them, understand them and find creative added-value ways forward. We are evaluating two potential additional focus areas— National and Regional WaSH Challenges in the US and the Water-Food-Climate-Energy Nexus.

focus areas

Focus Areas

Mo nito r ing, Evaluati o n and Lear nin g fo r WaS H d r in k in g wat e r fo r a l l

Wa SH Gover nanc e

G loba l Aca dem ic

A da ptin g to Wat e r Sca r cit y an d C l i m at e Change

L ea der s h ip

(in evaluation)

N ati o nal and Regio nal WaS H C hal l enges in the US (in evaluation)

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Wat e r - F o o d C l i m at e - Ene rgy N e x us

Sanitati o n fo r the 2 1st C entury


M o nitorin g , Evaluation and Le arning f or WaSH Despite substantial progress in increasing access to improved water sources over the past few decades, limited data are available on the impact and outcomes of investments in WaSH. Even though many organizations conduct program monitoring, and some even conduct periodic evaluations, the WaSH sector is lacking a robust set of standardized indicators for tracking program outcomes. The Water Institute is developing a set of standard indicators that enable organizations and funders to measure and improve the performance, outcomes and sustainability of their WaSH programs. By adopting the set of indicators, organizations can improve and accelerate the impact of their WaSH programs and reach the most disadvantaged and underserved populations. Quality improvement methods and tools will help direct resources to the most effective programs and help target the areas and individuals most in need. The Water Institute is working with organizations to collect, analyze, and interpret data and turn lessons learned into action for continuous quality improvement in WaSH. We have created an online resource, the Virtual Learning Center, to facilitate and accelerate monitoring, evaluation and learning. The Virtual Learning Center (VLC) is a platform for global practitioners to share knowledge, ideas and experiences. This VLC facilitates training in the collection and analysis of WaSH monitoring data, and supports the dissemination of knowledge and innovations relevant to WaSH implementers and partners in the field. We are applying an evidence-based, data driven approach to address cross-cutting WaSH issues such as: the unserved and ultra-poor; WaSH in schools; sustainability; and information and communications technologies for WaSH monitoring. Through our research and systematic reviews of WaSH data, we work to strengthen WaSH programs worldwide in the post-2015 period and are dedicated to increase and improve the quality of monitoring, evaluation and learning.

Pr oject: Monitoring, Evaluation and Learning of the Conrad N. Hilton Foundation Water, Sanitation and Hygiene Initiative The Water Institute is working with Hilton Foundation partners in West Africa, India and Mexico to measure progress of their WaSH programs and advise them on quality improvement opportunities. Current Hilton Foundation WaSH Partners include: The Aga Khan Foundation, Alternativas y Procesos de Participacion Social A.C. de C.V., The Desert Research Institute, The Foundation Center, IRC (International Water and Sanitation Center), The Millennium Water Alliance, The OneDrop Foundation, Safe Water Network, Water. org, WaterAid, Water and Sanitation for Africa (formerly CREPA), World Vision and UNICEF. Implementers, technical advisors, research groups, advocacy partners and knowledge managers were all involved in developing a core set of indicators and multiple learning tools for immediate and continuous quality improvement for partners to increase the effectiveness of WaSH programs.

T he W ater I nstitute at U N C


The International Network on Household Water Treatment and Safe Storage is a WHO and UNICEFled global alliance of more than 150 non-profit organizations, governments, research institutions and private sector firms working to increase access to safe drinking-water. With support from the P&G Children’s Safe Drinking Water Program, The Water Institute has provided communications support to Network members since 2010. Our activities have included supporting the dissemination and uptake of a new WHO & UNICEF toolkit on M&E through public presentations, webinars and learning workshops.

Participants at the Network’s Regional Workshop on HWTS for West Africa in Accra, Ghana.

Insi ght: Getting Wet, Clean and Healthy: Why Households Matter (Bartram et al., Lancet, 2012)

4.5 Projected Population and Number of Households normalized to 1990 Value (year value/1990 value)

France - Households France - Population


focus areas

Pr oject: HWTS Network: UNC Support to the WHO, UNICEF and Others

Dominican R. - Households Dominican R. - Population 3.5

Ethiopia - Households Ethiopia - Population





1.0 1990




Projected trends in population and number of households normalized to 1990 values

60 53

Unsafe (Adjusted for Water Quality and Sanitary Risk)

Projected Without Safe Water (%)



46 (projected)

40 Unsafe (Adjusted for Water Quality Estimates)

37 30

26 (target)

28 20 23

26 (projected)

Current MDG indicator definition of unsafe as unimproved 18 (target)

20 17 14







9 (projected)


Comparison of MDG Target 7c baseline and target when including and excluding fecal contamination and sanitary risk in water safety

Insi ght: Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress (Onda et al., International Journal of Environmental Research and Public Health, 2012) At the time Target 7c of the MDGs was developed, there was no credible monitoring alternative to counting households using various types of sources of drinking water. Doing so meant that no account was taken of actual water safety. With support from IAPMO, Water Institute researchers used existing data to re-calculate progress accounting for safety, showing that a total of 1.8 billion people using piped or other improved water sources in fact receive unsafe water, a shortfall of 10 percent of the global population towards the MDG target in 2010 rather than the official ‘on track’ estimate. The health and development implications suggest that greater attention is needed to better understand and manage water safety.

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0 1990

12 (target)


Slowing population growth will not substantively benefit progress on drinking water and sanitation because water and sanitation services are increasingly delivered to households, not individuals. Worldwide, the number of households is increasing rapidly, and will roughly triple from 1.3 billion to 3.6 billion between 1990 and 2050. We show that challenges in maintaining and expanding drinking water and sanitation coverage are underestimated, progress is overestimated, and that improved indicators and monitoring of access to water and sanitation are needed to ensure that scarce public resources are focused on underserved populations.


WaS H Governa nce Many WaSH interventions fail prematurely (for example, it has been estimated that one-third of hand pumps in subSaharan Africa do not work at any one time). Other interventions are under-invested, with inadequate replacement of aging infrastructure in both developed and developing countries. Resilient institutions, appropriate policies and efficient, implementable regulations are instrumental in sustaining drinking water and sanitation services. We seek to understand how institutions, stakeholders, policies and policy instruments, such as regulations, combine to optimize access, quality and benefits of water and sanitation services. Our research spans governance on the local, national and international levels. Better understanding of the determinants of sustainability of established interventions, and of the scalability of proposed interventions could contribute to improving sector performance. These determinants include the “enabling environment:� institutions, policies, regulations and the influences of social, cultural, political, economic and environmental circumstances. We have conducted research on progress towards the MDG target for water and sanitation and our WaSH Governance work contributes to the development of post-2015 Sustainable Development Goals. We undertook a number of studies for UNICEF related to WaSH monitoring in the context of post-2015 development agenda discussions; this and other work informed WHO/UNICEF Joint Monitoring Programme (JMP) working group recommendations about future global WaSH targets and indicators.

Pr oject: Water Wisdom: Developing Local-global Capacities in Managing Water Completed in 2012, the Water Wisdom project, funded the NIH Fogarty International Center, addressed how to maximize health and social benefits from investments in WaSH by improving the quality of local and global policy and program implementation. Working in Brazil, Ecuador and Malawi, we examined how information is collected, made available and used; and how new technology might overcome critical constraints. The project established new approaches for designing institutional and technological systems to provide accurate and timely information in the appropriate format to support improved WaSH policy-making and program implementation. This research program contributes to identifying how to analyze and use evidence in decision-making within institutions on regional, national and global scales.

Pr oject: Identifying Barriers and Levers to Advancing HWTS to Scale

T he W ater I nstitute at U N C


This study, sponsored by PATH and UNICEF, sought to better understand the enabling environment for the scale-up and sustainability of household water treatment and safe storage. We explored obstructing and enabling factors through interviews, focus groups and online surveys with diverse professionals. The results were used to develop three assessment tools that could be used to determine the likelihood of scaling up a particular HWTS product in a country, the readiness of national governments to scale up HWTS, and factors for implementing interventions in a particular community. We concluded that it is critical to consider the target population, the organization/ intervention characteristics and the enabling environment. The results from the study have been presented at the HWTS Network’s Southern African regional conference and the UNC Water and Health Conference, and will be described in a journal publication.

E quity I nde x



lower middle income

low income


upper middle income

high income

(b) -1.0 100




Gross National Income per capita Gross National Income per capita


Water and sanitation was recognized as a human right in 2010, making countries responsible for progressively realizing universal access. Existing indicators measure either the level of fulfillment of waterrelated goals or rates of change of target indicators. Neither of these methods allows the progress made by countries to be fairly compared against each other and across time. Water Institute researchers created an Equity Index to evaluate country progress in realizing substantive equity for the right to water. They found that most of the 56 countries analyzed are achieving some progress in reducing inequality. These index scores make it possible to: rank and compare countries, detect countries that are non-compliant with the principle of progressive realization and re-direct WaSH policy and program efforts to areas of need.

focus areas

I nsight: Equity in Water and Sanitation: Developing an Index to Measure Progressive Realization of the Human Right (Luh et al., International Journal of Hygiene and Environmental Health, 2013)


I nsi gh t: Post-2015 Global Monitoring of Water Safety As part of a study for UNICEF on urban monitoring of WaSH for the Post-2015 development framework, The Water Institute supported the WHO/UNICEF Joint Monitoring Programme’s Water Working Group in exploring the feasibility of different approaches to global monitoring of drinking water safety. We identified three approaches to water quality data: dedicated water quality surveys, integration of water quality testing within household surveys and data from regulatory agencies and/or utilities; then assessed their suitability for global monitoring purposes, and calculated preliminary cost estimates. We recommended that water quality information be systematically collected for selected parameters both at the point of service delivery/collection and at the point of consumption, where possible.

Relation to water quality

Example DATA source


Systematic reivew of expert opinion on likelihood of contamination/ protected sources

JMP (derived from household surveys and censuses)


Service levels are being devised and may include water quality measures


Continuity of service

Potential indicator of infiltration risk in piped supplies, will be source dependent


Leakage rate

For piped supplies, the leakage rate may be a proxy for infiltration, especially if there are intermittency problems



Individual perception of water quality. Indicator of acceptability, but a poor predictor of microbial quality

Gallup survey Household surveys WASH Cost


Not considered a likely proxy for priority health contaminants, especially microbial; possible indicator for acceptability


Sanitary risk

May be a good proxy for water quality; a direct measure of risk


Free chlorine (preferably with Turbidity measure if above/or 5 NTU)

May be a good proxy for microbial contamination in some supplies


P roposed indicators for water quality

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Sa nitati on for th e 2 1 st C e ntury Sanitation is the promotion and use of hardware for the safe management of human excreta. In 2011, about 2.5 billion people in the developing world lacked access to basic sanitation, including one billion who practice open defecation. As most of the sickness and death associated with inadequate WaSH results from fecal-oral disease transmission, management of human feces constitutes the heart of the WaSH challenge. An increasingly urban world complicates sanitation, as more human waste is concentrated into smaller areas, increasing exposure while limiting simple technical options. While sanitation’s importance has become increasingly recognized over the past 15 years, we are still ignorant of the basic interactions between pathogens, pathways, practices, players and policies. Fundamental processes are poorly understood, particularly in environmental health and human terms: Which exposures to human feces constitute the greatest risks? Which are most amenable to control? What factors drive adoption of sanitation? What happens to wastes between the toilet or latrine and their return to the environment? How can sanitation promotion efforts best be managed where resources are scarce? Understanding “what is going on now” is a first step in developing realistic health interventions. A major research opportunity in sanitation, particularly in urban areas, is to understand clearly where the risks arise, and what can be done about them. Quantitative microbial risk analysis and geographic information system (GIS)based epidemiology are tools that may identify critical risks in dense urban slums in the developing world and identify clear targets for intervention. This could permit the development of risk based sanitation interventions that focus on where the greatest risks can be most economically reduced. These need to be coupled with analysis of the human and sanitation management systems (formal and informal), and the engineering, economic and financial constraints to innovate and overcome current constraints. The Water Institute assembles teams with multi-disciplinary skills including microbiologists, anthropologists, marketing specialists and sanitation engineers to contribute to new insights on sanitation implementation, and its monitoring and evaluation.

Pr oject: Testing Modified Community-led Total Sanitation for Scalability CLTS is an approach to sanitation promotion that has spread to countries around the world in the past 15 years. It seeks to encourage the construction and use of sanitation facilities through “triggering” of grassroots community mobilization. When successful, as has been reported from many parts of South Asia, this promotes a community-wide commitment to becoming opendefecation free. Success depends on the quality of the triggering; but the number of development professionals skilled in such participatory mobilization approaches is limited. PLAN International and others are eager to learn who can take on this triggering role: natural leaders from the community, local school teachers and health sector workers. The Water Institute has designed, and is implementing, rigorous evaluation studies of PLAN-supported CLTS projects in Ethiopia, Ghana and Kenya to learn the effects of such modifications to the CLTS approach, see how they influence success or failure, and learn lessons for future intervention design. This work is important not only for the questions it may directly answer, but also for the methodological lessons, as to how such studies can best be conducted, that may assist other applied researchers in sanitation in the future. T he W ater I nstitute at U N C


As part of a larger study for UNICEF on urban monitoring for the Post2015 Development Framework for WaSH, The Water Institute supported the Sanitation Working Group in development and analysis of options to monitor progress towards “complete management of human excreta,” which is the chain of treatment and disposal (or lack thereof) prior to the return of treated excreta to the environment. This responds to the growing recognition of clandestine and dangerous dumping of latrine wastes after emptying, of uncontrolled sewage discharges. Neither of these can be monitored through the current JMP method. A number of options were developed, discussed with the Working Group and are described in a working paper. While much work remains to be done on the practical details of such monitoring, The Water Institute’s presentation showed promise and the Working Group adopted the monitoring of the complete management of excreta in its recommendations.

100 Sewerage Connection Sewerage Connection and Treatment % of Population with Access


focus areas

P r oject: Support to the WHO/UNICEF Joint Monitoring Programme’s Working Group on Sanitation

Insi ght: Sanitation: A Global Estimate of Sewerage Connections without Treatment and the Resulting Impact on MDG Progress (Baum et al., Environmental Science and Technology, 2013)


JMP estimated that in 2010, 4.3 billion people were using an improved sanitation facility, and 2.6 billion people were 40 using an unimproved sanitation facility worldwide. However, monitoring of progress toward the sanitation component 20 of MDG Target 7c did not account for the need to protect communities and the wider population from exposure to untreated sewage. Water Institute researchers reassessed 0 Low Income Low Middle Upper Middle Higher Income the progress of 124 countries by classifying connections to Income Income sewerage as “improved sanitation” only if the sewage was Global access to sewerage connection alone and to treated before discharge to the environment. Redefining sewerage connection with sewage treatment in 2010, sewerage-without-treatment as unimproved sanitation in by country income group MDG monitoring would raise the 1990 baseline population using unimproved sanitation from 53% to 64% and the corresponding 2015 target from 27% to 32%. At the current rate of progress, we estimate a shortfall of 28% (1.9 billion people) in 2010 and a project 27% shortfall in 2015. This publication highlights the need to re-evaluate the JMP monitoring categorization “basic sanitation” to encompass both the individual and the collective right to a clean and healthy environment.

I nsi gh t: How Health Professionals Could Lever Health Gains from Improved Water, Sanitation and Hygiene Practices (Platt and Bartram, Perspectives in Public Health, 2010)

• Prima non nocere: Enact, implement and enforce minimum standards for WaSH in all types of healthcare facilities including both physical facilities and their safe functioning and patient safety and infection control measures • Review curricula and in-career development for all health professionals to ensure relevant and usable WaSH components are incorporated • Update clinical practice guidelines: When patients are present with diseases associated with poor WaSH practices, offer longterm preventive solutions in addition to immediate treatment • Provide patient education materials in healthcare settings such as waiting rooms and clinics • Actions speak louder than words: Remember in your daily interactions that you can model safe WaSH-related practices to those around you

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There are missed opportunities for coordination and collaboration between the health and WaSH sectors that contribute to the disease burden associated with inadequate water, sanitation and hygiene. With support from WaterAid, we applied an established health system functions framework to water, sanitation and hygiene and concluded that health agencies and professionals have the potential to improve the implementation, impact and sustainability for safe WaSH-related practices.

How health professionals can advance health by engaging in WaSH


A da pting to Water S carcity and Climate C hange Water scarcity arises when resources are insufficient to meet the sum of the demands made on them, whether from agriculture, industry, household use, environmental or other needs. By 2025, 1.8 billion people will be living in countries or regions with absolute water scarcity, and two-thirds of the world’s population could be under water stress. To some extent, water availability can be improved by storage in dams, groundwater recharge and planned re-use. However, climate change is adversely affecting availability in most regions and is projected to result in increased flooding and drought, rising sea levels, amplified coastal storminess and an overall decrease in precipitation in most subtropical regions. Drinking water and sanitation facilities and services in both developed and developing nations are vulnerable. The impacts of climate change are likely to have substantive adverse impacts on drinking water and sanitation services, increasing the rate of failure and the costs of maintaining and extending coverage. The Water Institute’s work on climate change focuses on assessing risks to drinking water and sanitation at different scales; identifying and ranking opportunities for adaptation; and supporting adaptation through identification, collation and dissemination of good practices. We incorporate adaptation considerations across our work in other focus areas and work with partners to assess vulnerabilities in their programs and projects and identify adaptation opportunities. We believe that understanding the vulnerability of WaSH services and anticipating future challenges can inform adaptation strategies that will help to increase resilience to climate change.

Pr oject: Water and Sanitation Service Sustainability: WaSH and Climate Change Country Assessment UNICEF country programs, designed and implemented in response to national priorities, need to be adapted to the potential adverse effects of climate change. Better information is needed to harmonize interventions, lessen the risk to countries and communities, and ensure that progress achieved is not lost. The Water Institute assessed 20 UNICEF “WaSH Priority” countries, evaluating their vulnerability, resilience and adaptive capacity to the major hazardous events associated with climate change. Our assessment work formed the basis for an internal UNICEF analysis of country-specific vulnerability and preparedness for WaSH programming effectiveness and sustainability.

P roj e ct: County-level Ranking of US Drinking Water and Sanitation Systems for Climate Change Vulnerability and Preparedness Extreme weather events, like floods and droughts, are expected to be more frequent and severe due to climate change. These climate-related hazards will adversely impact both drinking water and sanitation systems. The effect of these hazards is dependent on a number of factors: the sensitivity, resilience, and adaptive capacity of the affected water and sewage or septic systems, the geographical location and the weather event itself. Using data for US states and municipalities, and made possible by support from Wells Fargo, The Water Institute team developed a model that analyzes and ranks US counties by their preparedness and vulnerability to climaterelated hazards. The system enables at-risk areas to be identified, so that adaptations and potential innovations can be suggested for most vulnerable areas.

R ank 1 ( L east vulnerable ) T he W ater I nstitute at U N C



R ank 2 R ank 3 R ank 4 R ank 5 ( most vulnerable )

V ulnerability due to flood in N orth C arolina


Household Water Treatment and Safe Storage (HWTS)

Improving Resilience of Protected Wells to Flooding

Increasing the Use of Water-efficient Fixtures and Appliances

Leakage Management, Detection and Repair in Piped Systems


Post-construction Support (PCS) for Community-managed Water Systems

Rainwater Collection from Ground Surfaces—Small Reservoirs and Micro-catchments

Rainwater Harvesting from Roofs

Water Reclamation and Reuse

Water Safety Plans (WSPs)

Water Conservation

Stormwater Control and Capture

Resilience to Water Quality Degradation

Preparation for Extreme Weather Events

Ground- water Recharge

Diversification of Water Supply

Boreholes/Tubewells as a Drought Intervention for Domestic Water Supply

Water Institute researchers wrote this guidebook, published by the UNEP Risoe Center and freely available online at http://www.waterinstitute. unc.edu/media/TNAhandbook_ Water.pdf. It describes adaptation strategies in the categories of water conservation, storm water control and capture, resilience to water quality degradation, preparation for extreme weather events, diversification of water supply and mitigation. It is a practical tool for use by a broad range of stakeholders, including those in governmental agencies, water utilities, community water boards, nongovernmental organizations and private sector companies.

focus areas


Insi ght: Technologies for Climate Change Adaptation – Water Sector Guidebook (Elliott et al., UNEP Risoe Centre, 2011)

Insi ght: Evaluating Countrylevel Population Vulnerabilities to Water Access Due to Climate Related Hazards Using High Spatial Resolution Methods (Elliott et al., submitted)

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With funding from The Wallace Genetic Foundation, The Water Institute developed a methodology to determine the vulnerability and preparedness of drinking water systems to climate-related hazardous events such as flood, drought and cyclone. We produced the first ever country-level ranking of population-level vulnerability, presented in maps depicting risks due to cyclone, flood and drought and for the sum of the three hazards.


D r inkin g Water for All Today, reliable safe water is available to a minority of the world’s population. Small and rural water supplies have higher rates of failure and of contamination in developed and developing countries worldwide. Evidence indicates that the key failure point is in back-up to community level operation and maintenance; especially for technical and financial management. The potential benefits from innovation in management of these small systems are large. Many urban systems deliver water intermittently and large populations collect water from community sources. Outbreaks in systems that meet, or appear to meet, drinking water standards suggest that periodic assessment of the water quality does not consistently result in the provision of safe water. Preventive management has the potential to reduce public health risk and to enhance good asset management. Strategies to make systems that deliver safe water more robust, by systematically recognizing and addressing risks, are embodied in the concept of Water Safety Plans (WSPs) which have been widely adopted and applied since their introduction by WHO in 2003. We are interested in determining the characteristics of settings that help maximize benefits of WSPs.

P r oj e ct: The Last Mile of Safe Drinking Water Delivery This project, sponsored by IAPMO, explores opportunities to reduce risks for contamination between sources of safe water and water use in homes. It includes assessment of plumbing code enforcement in the United States in three phases. Phase One involved categorizing US states according to the types of state-level plumbing code adoption, enforcement procedures and administrative rules. Phase Two includes assessing the frequency of local plumbing code enforcement, the capacity of local plumbing code enforcement departments, and perceived levels of compliance with plumbing codes, through a nationally-representative survey. Phase Three describes the relationship between state-level plumbing regulation types and local enforcement behavior and efficacy, using data collected in the first two phases.

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Pr oject: Public Health and Social Benefits of Athouse Water Supplies Funded by DFID and in cooperation with the Universities of Leeds and East Anglia, UK, we sought to understand the health and social benefits of at-house water supply. We undertook systematic literature reviews, analyzed global data, and implemented field studies in Ghana, Vietnam and South Africa. We concluded that at-house water supply has significant, measurable benefits when compared with use of shared water sources, outside the home, if the service provided is reliable. Reliable at-house water supply are associated with higher volumes of water use, greater practice of key hygiene behaviors, a reduction in musculoskeletal impacts associated with carrying water from outside the home, and improved water quality. Our work suggests a policy shift towards the promotion of reliable household access as the international benchmark for water supply, in contrast to today’s focus on community-shared sources.

Insi ght: Benefits of Water Safety Plans: Microbiology, Compliance and Public Health (Gunnarsdottir et al., Environmental Science and Technology, 2012)

18% 16% 14% 12.6% 12% 10.3%

10% 8%





4% 2%






1.0% 0.0%

0% V4




Non-compliance before WSP


Average all

Non-compliance after WSP

M ean annual noncompliance with I celandic D rinking Water R egulation at five water utilities before and after W S P

This study, led by Icelandic colleagues with support from the Environmental and Energy Research Fund of ReykjavĂ­k Energy, collected and analyzed surveillance data on water quality and diarrhea in Iceland, one of the first countries to legislate the use of Water Safety Plans. Results showed that, following WSP implementation, microbiological water quality improved, compliance with drinking water standards increased, and incidence of diarrhea declined. People living where a WSP was implemented were 14 percent less likely to develop clinical diarrhea. This study confirms that there are substantive benefits of WSPs, especially on water quality and waterborne disease reduction.

focus areas


I nsi gh t: Aquatest Research Program: Testing Scenarios and Global Regulatory Review The Aquatest project, led by the University of Bristol, UK, examined improved, cost-efficient approaches to monitoring drinking water quality to support better management of water safety in urban and rural settings. The Water Institute contributed to two components of this project: evaluating realistically-achievable changes to current water quality monitoring practices in response to potential simplified testing methods, and characterizing regulatory approaches and monitoring requirements for microbial contaminants of drinking water supply worldwide. 14


Transport cost Labor cost


Test cost




0 Large Urban

Small Urban + Rural


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C ountry-averaged marginal cost per test for current ( left bar ) and modified ( right bar ) scenarios



Focus Areas in Evaluation I n add iti o n to o u r fi v e e stab l is hed fo cus ar eas, we are evaluating two further areas for potential inclusion in our future plans:

National a nd Regional WaSH Challe nge s in the US In the early 20th century, the US provided international leadership in establishing drinking water and sanitation services for its cities and rural populations. The results demonstrated the health benefits of drinking water treatment on control of typhoid and of introducing disinfection. Today the infrastructures for these critical services are aging and remain incomplete. The American Society of Civil Engineers routinely grades US water and sanitation infrastructures with a ‘D.’ Septic tank failure rates are common and small water systems, which supply around 20 percent of the population, often fail basic safety standards. There are opportunities to improve on current practices that could enhance health protection, service delivery or contribute to containing costs. We are focusing our preliminary work on two challenges: tackling the specific problems of small and marginalized communities; and the potential contribution of Water Safety Plans as an approach that has demonstrated benefits in other developed nations. In both cases, we seek to provide added value links between our activities in the Southeastern US and abroad. Project: Racial Disparities in Access to Public Water and Sewer Service in North Carolina: Public Health Impacts and Policy Solutions

Wake C ounty ( N orth C arolina ) pockets of low percentage water service by 2 0 1 0 census block

This project, funded by the Robert Wood Johnson Foundation, focuses on reducing racial disparities in access to public water and sanitation services. Substantial disparities exist in North Carolina, a legacy of racial segregation. This research aims to discover the roles of race and socioeconomic status in determining the likelihood of access to WaSH services, as well as the contribution the lack of WaSH services make to health disparities, and the resulting statewide health and economic costs. The results will address the policy, system and administrative strategies that are most effective in reducing disparities in the effectiveness, efficiency and outcomes of public health strategies delivered to racial and ethnic minority and low-income populations.

P r oject: Water Safety Planning in Small Municipal and Private Water Supply Systems in North Carolina

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Water Safety Plans were developed by the WHO as a means to manage risks within drinking water systems. They involve a preventive approach to identify and control risks in a drinking water system from catchment to consumer. With support from NEHA and CDC, a team of Water Institute researchers is identifying the potential impacts of introducing Water Safety Plans in small municipal and private water supply systems in North Carolina. We have identified locations for pilot projects that are feasible and appropriate, and are discovering factors that either facilitate or inhibit the implementation of the WSP process in the US context.

Global trends such as population growth, urbanization and rising living standards are increasing the demands for water, food and energy, which will impact the security and sustainable use of natural resources. If current trends continue: agriculture will have to produce 70 percent more food by 2050, primary energy needs will increase by 50 percent by 2035 and demand for water will exceed global availability by 40 percent in 2030. In order for the world to reduce hunger and eradicate poverty and to maintain standards already achieved, attaining security for water, energy and food for all people is essential. This challenge is becoming even more critical with the impacts of climate change.


P roj e ct: Nexus Conference


In 2014, The Water Institute will host the Nexus 2014: Water, Food, Climate and Energy Conference. The Conference will bring together researchers, policy-makers and practitioners from government, civil society and business internationally to address the relationships among water, climate, food and energy, and the impacts on security, sustainability and development.

I nsigh t: WHO Zoonoses: Workshop on Emerging Waterborne Infectious Disease (2009) The Water Institute, on behalf of the WHO, hosted an international meeting of experts to discuss the impact of zoonotic microorganisms linked to waterborne disease in humans and identify potential future disease threats. The resulting book, Animal Waste, Water Quality and Human Health (Dufour, Bartram, Bos and Gannon, Eds.,2012), provides information to help agencies anticipate future waterborne disease problems and determine whether existing practices are sufficient to protect human health.

I nsi gh t: World Water Development Report (UN, 2012)

FOOD N EX U S 2014




f o c u s a r e a s I N E V A L UA T I O N

Wat e r - Food - Clim ate- Ener gy Ne xus

• More than 85% of the world’s fecal wastes are from domestic animals, such as poultry, cattle, sheep and pigs, which contaminate recreational waters and drinking water sources with excreta and pathogens. • Most recognized “emerging” diseases are from zoonotic sources.

D river , pressure , state , e x posure and effect for water - based diseases ( Gentry-Shields and Bartram, 2014)

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Driver Pressure State Exposure Health Effect The World Water Development Report is the UN’s flagship report on water that Population Growth Exposure to assesses the state of the world’s fresh Uncontained contaminated Concentration Schistosomiasis and untreated waters (e.g. of pathogens excreta water resources and provides tools for bathing) Agriculture implementing sustainable water usage. Concentration Water Institute researchers wrote the of intermediate host chapter about the underlying driving Line Strength of Climate Change Thickness association forces of water-related diseases for Changing Strong environmental the 2012 edition of the report. The characteristics Intermediate Dams and work involved adapting the DPSEEA irrigation Fair projects framework to this new purpose and now has been published in a scientific Modify or journal. The DPSEEA frameworks indicate Improved Environmental Environmental Impact manipulate Action Health Assessment sanitation modification manipulation human behavior that a select group of driving forces, including population growth, agriculture, infrastructure (dams and irrigation), and climate change, is at the root cause of key global disease burdens. Sanitation was found to be a widely applicable and effective intervention, targeting the driver/pressure linkage of most of the water-related diseases examined.


Research Wat e r I nstitut e r e s e a r c he r s wo r k with visiting and collaborating scholars worldwide. Our research identifies emerging trends and examines ongoing problems in WaSH, health and development. The four primary objectives of our research strategy are to: produce a coherent, focused research effort; support UNC faculty research relevant to the Institute and its focus areas; ensure our research is accessible to a variety of audiences; and identify critical new and emerging issues. Water Institute researchers work toward these objectives through the integrated processes of defining research problems, building teams to explore them, producing deliverables and communicating findings.

I nputs Water Institute researchers identify, develop and submit grant proposals that align with one or more of our focus areas. Our annual number of research grant proposals has progressively risen since 2010; and the success rate of awards for submitted proposals approaches 50 percent. We create collaborative research with UNC faculty and departments as well as governments, intergovernmental organizations, NGOs, universities and other research institutes. Our research is often multidisciplinary, bringing in diverse perspectives from fields such as engineering, epidemiology, health behavior, environmental sciences, human rights law and public policy. Through this intersection of viewpoints, we are able to provide distinct approaches to address complex challenges in WaSH, health and development.

R esearch I ndicators


Proposals submitted Awards granted


Active projects




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0 2009-2010




Dr. Jacqueline MacDonald Gibson joined The Water Institute as our Director of Research in September 2013. In this role, she steers the implementation of the overall research effort of the Institute. She has been a professor in the Department of Environmental Sciences and Engineering at UNC since 2007. Her own research focuses on constructing mathematical models that can be used to assess the impacts of alternative policies and aid in decision-making on environmental quality and public health.

In the three academic years to 2012-13, we produced more than 60 publications. Nearly two-thirds of our research outputs have been scholarly articles in peer-reviewed journals. We also authored and edited book chapters and have contributed to publications such as the UN’s World Water Development Report and UNEP’s Technologies and Practices for Climate Change Adaptation in the Water Sector. Our outputs also include invited presentations made at conferences around the world.

I m pacts Published peer-reviewed papers with increasing citation rates illustrate The Water Institute’s research impact. Water Institute research papers have been cited 321 times, and as of December 2013, we have an h-index of 8 and an i10-index of 8, according to Google Scholar. Our research provides evidence to support effective decision-making on WaSH. The article Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress (Onda et al., International Journal of Environmental Research and Public Health, 2012) was cited 40 times by various academics and practitioners, including multiple UN agencies, between its publication in 2012 and 2013. Another article, Sanitation: A Global Estimate of Sewerage Connections without Treatment and the Resulting Impact on MDG Progress (Baum et al., Environmental Science and Technology, 2013), had already cited 10 times between its publication earlier in 2013 and December 2013.



C itations to Water I nstitute A rticles *


0 2009





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“The Water Institute at UNC,” Google Scholar, accessed October 30, 2013, http://scholar.google.com/citations?user=yodNYMAAAAAJ&hl=en


Knowledge and Information Management W e i de ntify, p r o d uce a n d d ist r ib ut e relevant and timely insights on WaSH, health and development. We seek to support effective policy-making and decision-taking, which protect and improve human health worldwide and foresee emerging risks. The Water Institute is committed to transforming science into meaningful findings and actionable recommendations. Our strategy aims to: utilize innovative and tested approaches to identify relevant WaSH information and knowledge; create mechanisms for capturing knowledge in ways pertinent to specific target audiences; and disseminate and share lessons to provide effective support for decision-makers and policy-makers. The Water Institute’s knowledge and information management activities take a variety of forms and we use a range of dissemination channels. Aside from our peer-reviewed publications, we are bridging the gap between researchers, policy-makers and practitioners through policy briefs, conferences, invited presentations, maps, virtual learning opportunities, working group participation and workshops. Our communications tools and partnerships multiply the reach of these efforts, such as our newsletter with more than 15,000 recipients. With WHO we are developing briefing notes to improve the uptake and impact of household water treatment and safe storage. Our activities have provided insight into achieving progress on vexing issues in the WaSH sector, from accounting for water quality in monitoring MDG progress to understanding the needs and perspectives of government finance ministries on funding WaSH. We seek opportunities to share our work with the WaSH community and other audiences through invited presentations at other events. Water Institute staff addressed the University of Oxford’s International Conference on Water Security, Risk and Society on the status of water resources worldwide and recently delivered two presentations and a workshop on monitoring and evaluation in Ethiopia. We also presented on what works in drinking water and sanitation at the UN General Assembly MDG summit in 2010.

Policy Brief for the Steering Committee of the Sanitation and Water for All Partnership

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The meeting participants with Global Research Institute fellow Clarissa Brocklehurst (right).

The Water Institute and the Global Research Institute (GRI) at UNC hosted a meeting of senior government officials from six African countries to discuss government decision-making related to water, sanitation and hygiene. The meeting was led by GRI Fellow Clarissa Brocklehurst. The participants, who came from Nigeria, The Gambia, Sierra Leone, Uganda, Liberia and South Sudan, covered a number of subjects: the process by which finance ministers are briefed, the role of finance ministries in shaping WaSH investments and the perceptions of finance ministers with respect to WaSH. The insights and lessons gained from this dialogue were captured and shared in a policy brief and recommendations for WaSH advocates, sector stakeholders and Sanitation and Water for All.

Q uarterly I S S N : 2 0 4 3 - 9 0 8 3 I WA P ublishing : London , E ngland

Wa S H M E L V irtual L earning C enter

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In collaboration with IWA, we publish the Journal of Water, Sanitation and Hygiene for Development. This peer-reviewed journal is devoted to the dissemination of high-quality information on the science, policy and practice of drinking water supply, sanitation and hygiene at local, national and international levels. In its first few years of publication, the journal has become a valuable and expanding resource in the sector and was recently included in Thomson Reuters’ Web of Science, an index of scholarly and influential works. The journal is on track to receive an impact factor rating in 2014.

K n o w l e d g e a n d I n f o r m a ti o n M a n a g e m e nt

Our research into the climate change vulnerability and preparedness of US states and counties has shown that impact is dependent on a number of factors. We are working to make this data available online via our website and to create a ranking system that will enable identification of at-risk areas and targeting of investments in adaptation and resilience strategies. We work with Plan International and the Hilton Foundation and their partners to strengthen implementation according to best practices and lessons learned from our research efforts. In these projects, we are creating virtual knowledge and learning hubs for sharing resources, discussing challenges and issues with the goal of facilitating program improvement. We participate in working groups convened by WHO and UNICEF for the post-2015 MDG targets and indicators for water and sanitation, and were asked by WHO to convene a gathering of international experts to discuss research on the impact of waterborne zoonotic disease in humans and identifying potential future disease threats.


Networking and Partnership Development W e ai m to br in g to g e t he r individuals and institutions from diverse disciplines and sectors and empower them to work together to solve the most critical global issues in WaSH, health and development. Our objectives are to convene those working in the WaSH sector to address major challenges through annual conferences, to develop collaborating partnerships internal and external to UNC, and to actively engage in international and domestic WaSH coalitions.

Annua l Water a nd Health Conf e re nce Each year we host the Water and Health Conference, which attracts around 500 participants and focuses on the intersections of WaSH, health and development. Participants include researchers, practitioners, policy-makers, advocates, students and entrepreneurs from more than 50 countries.

C ountries of Attendees at the 2 0 1 2 Water and H ealth C onference



Denmark The Netherlands Germany Georgia Japan Italy Napal China Portugal Spain Switzerland Pakistan UAE Bangladesh Egypt Cambodia Sierra Leone Ghana India Oman Sudan Thailand Philippines Ethiopia Nigeria Uganda Malaysia Rwanda Tanzania Zambia Ireland

United States



United Kingdom France




South Africa

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The Water Institute was launched at the 2010 Conference, and over subsequent years the Water and Health Conference has become a well-respected global event that serves as a forum for research, learning and innovation. In 2012, there were more than 400 abstract submissions and more than 525 attendees. Organizations increasingly use the Conference as a launching pad for publications or activities, as UNICEF did in 2012 to launch its Raising Even More Clean Hands campaign. The Conference offers participants the opportunity to collaborate, network, discuss and discover new issues in WaSH through a mix of interactive sessions, presentations and keynote speeches. In 2012, participants had the chance to interact with the chairs of the post-2015 MDG working groups on WaSH of WHO and UNICEF. The exchange allowed the chairs to report on their group’s work and to hear feedback from those who may not otherwise have had an opportunity to voice an opinion.

Our staff, researchers and students seek out and work to establish enduring relationships with domestic and international partners. Our collaborators are those individuals and organizations we work with to implement our activities. We have more than 50 partners, which include governments, intergovernmental organizations, NGOs, private industry, universities and research institutes. We also collaborate with a number of UNC departments and faculty members. These partnerships support all facets of our work and allow us to provide sound science relevant to influencing policy and practice to improve human health and development. Many of our collaborators are identified alongside the description of the work we have done with them throughout this review. We are members of several international coalitions, including the Sanitation and Water for All Partnership (SWA), The Water and Climate Coalition, the International Network on Household Water Treatment and Safe Storage and the US Water Partnership. Our membership in these organizations enables us to contribute to solving larger WaSH challenges that require diverse resources. We offer our expertise and staff resources and support various activities, such as leading SWA’s Research and Learning Constituency, which makes existing information in WaSH relevant to SWA, and available and accessible to SWA partners. The Water Institute had a significant role in the planning and launch of a major new partnership in 2011. We worked closely with the US Department of State, the Global Environment and Technology Foundation and others to develop the US Water Partnership. This public-private partnership was formed to share knowledge, leverage and mobilize resources, and facilitate cross-sector partnerships to find solutions to global water accessibility challenges, especially in the developing world. The Water Institute was the only academic founding institution and we continue to help shape the partnership by participating in joint activities, chairing the membership committee and serving on the steering committee.

The US Water Partnership brings together more than 70 organizations with the goal of ensuring sustainable and equitable water management that benefits people and our environment through:

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• Improving WaSH access and quality of service. • Advancing integrated water resource management. • Increasing efficiency and productivity of water use. • Improving governance through stronger public and private institutions, policies and processes.

SWA is a global partnership of 90 developing country governments, donors, civil society organizations and other development partners working together to catalyze political leadership and action, improve accountability and use of scarce resources more effectively. Partners work towards a common vision of universal access to safe water and adequate sanitation.

N e t w o r kin g a n d P a r tn e r s hip D e v e l o p m e nt

C o l l a b orati ons


Teaching and Learning W e ai m to c r e at e a teaching identity that shares the benefits of The Water Institute’s access and approach to knowledge of WaSH and health, with a particular focus on graduate and professional development. As a single player among many building capacity in the WaSH sector, we need to focus our teaching in areas of specific expertise of our staff, faculty and partners. We: • Contribute to the courses, seminars and degree programs within the Gillings School of Global Public Health, and elsewhere on campus; • Respond to global, national and local needs by developing international and local teaching and learning partnerships that deliver innovative, relevant and highly accessible professional training programs; • Address contemporary challenges by developing interdisciplinary training opportunities that span the breadth of areas needed to solve WaSH problems. Our strategy-in-development for teaching and learning includes:

I nputs

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Participatio n a n d e n gag e m e nt ar e c ritica l to l e a r nin g , and these elements lie at the heart of our teaching. We cannot simply “transfer knowledge and skills to students,” but we can facilitate the learning about WaSH and health, which can only come from students’ active engagement. This means that in all our teaching we promote engagement, participation and exchange among participants and instructors. While not always easily managed in face-toface settings, fostering engagement and participation is even more challenging in distance learning. Distance learning is the key to Water Institute outreach in teaching and learning, particularly for our global constituency of practitioners at the intersection of WaSH, health and development. If well-managed, the potential impact of distance learning is huge. Distance learning is not a “soft option” for those who teach or those who learn. While modern technology allows greater flexibility in timing and location of learning, the course preparation and administration require additional rigor on the part of the teaching staff. With initial funding support from the International Water Association and in partnership with the University of Surrey, The Water Institute has developed and taught a distance learning course to 40 WaSH sector practitioners and funding agency staff from around the globe and within North Carolina. The course has been certified for three Continuing Education Units, and will be taught on an ongoing basis.

Professor Pete Kolsky joined The Water Institute as our Director of Teaching and Learning in June 2012. Dr. Kolsky is a proud alumnus of UNC’s MSEE degree program. His past experiences in water, sanitation and health include 12 years as a practicing engineer in the public and private sectors, 10 years of research, teaching and technical support at the London School of Hygiene and Tropical Medicine, and, most recently, 12 years with the World Bank, where he served as a focal point on sanitation issues. He has worked in more than 30 countries, and has lived at least a year each in Côte d’Ivoire, Egypt, Mozambique, Cambodia and Madagascar. His work at The Water Institute focuses on developing and implementing a practical and coherent strategy for teaching and learning, including the successful development and piloting of a distance learning course on Water Safety Planning.


A ll Wat e r I nstitut e t e ac hin g is fo cused o n o ur ar eas o f co m par ati ve advantage a n d e x p e rtis e . The sector does not need “copies” of existing courses, although combining courses may create synergistic opportunities. The Water Institute ensures that participants have ready access to experience and expertise in the courses we offer them, and this is most directly available to us from Water Institute, Environmental Sciences and Engineering, and Gillings School of Global Public Health faculty.

Outputs Fac e -to-fac e t e ac h in g sti l l m atter s! The contribution of The Water Institute to students in the Department of Environmental Sciences and Engineering and the Gillings School of Global Public Health contributes to the education of the next generation of leaders in WaSH and public health. Specialist residential short courses are planned in topics like WaSH as a Public Health Intervention. Both examples maximize the benefits of bringing a multi-disciplinary faculty face-to-face with a dedicated community of students for intensive exchange. The Water Institute contributes to teaching and learning on campus, including mentoring and support for student organizations, like Engineers Without Borders and A Drink for Tomorrow. We’re also in the process of preparing a textbook on WaSH and health as an authoritative source on these issues in developing and developed countries for the interdisciplinary teaching of master’s, doctoral and advanced undergraduate students. The revised UNC Master of Science in Environmental Engineering degree encourages participation from international WaSH professionals. Changes to the degree were designed to address more directly the demands of engineering practice and permit completion of the degree within a year. This non-research degree now allows those concerned with international WaSH to come to grips with current thinking and practice at a global center for water, health and development. T h e Wat e r I nstitut e wil l l e v e rage its other acti vities fo r teaching and le arnin g. Additionally, two of our projects have built-in opportunities for Water Institute teaching and learning in the field. Both The Water Institute and the Conrad N. Hilton Foundation saw the value of moving beyond a narrow “third party evaluation” of extensive water projects, and instead, building capacity for monitoring and evaluation in these projects so that all could learn the lessons from field experience. Similarly, the lessons learned with Plan International USA about CLTS promotion in Ethiopia, Ghana and Kenya will be more widely shared through regional and global learning events.

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As our Teaching and Learning work grows, we will contribute to capacity building in the water, sanitation, hygiene and health sector through training the next generation of WaSH professionals. Fourteen of our 17 graduates have gone on to careers in the WaSH sector. There are many career options for Water Institute-affiliated students after graduation, including: international nongovernmental organizations (e.g. CARE, World Vision, Water Aid), private sector consulting groups or firms, governmental development agencies involved in water, sanitation and hygiene in developing countries (e.g. USAID, WHO/PAHO, the World Bank, UNICEF), as well as universities and research institutes with interests that overlap with our own.


Water Institute Staff Dr. Jamie Bartram

Director Jamie Bartram is the Don and Jennifer Holzworth Distinguished Professor in the Department of Environmental Sciences and Engineering at UNC. He was awarded the International Water Association’s Grand Award in 2004 and holds honorary professorships at the Universities of Bristol and Surrey, UK. Jamie has more than 25 years of experience in international policy, research and advisory work in public health and disease prevention, especially in relation to environment, health, water supply and sanitation; he has worked in more than 30 developing and developed countries worldwide. He spent 10 years as coordinator of Water, Sanitation, Hygiene and Health at the WHO headquarters, where he led reform of the WHO’s international monitoring and standard-setting activities and developed a series of influential communities of practice.

Dr. Pete Kolsky

Director of Teaching and Learning Dr. Pete Kolsky is a Professor of the Practice in Environmental Sciences and Engineering and Director of Teaching and Learning for The Water Institute, where he focuses on appropriate distance learning for sector professionals and community of practice fora. As a Former Senior Water and Sanitation Specialist in the Latin America and Caribbean Region of the World Bank, Dr. Kolsky, brings to the Institute over 35 years of experience in the issues of water, sanitation and health in developing countries.

Dr. Jacqueline MacDonald Gibson

Director of Research Dr. Jacqueline MacDonald Gibson steers implementation of the overall research effort of the Institute. Her research focuses on constructing mathematical models that can be used to assess the impacts of alternative policies on environmental quality and public health. She has been a professor at UNC in the Department of Environmental Sciences and Engineering since 2007. Previously, she was the Associate Director of the Water Science and Technology Board at the US National Research Council.

Marissa Streyle

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Manager of Networking and Partnerships Marissa oversees Water Institute conferences and events, and she works closely with our partners and collaborators to ensure that we are forwarding research and knowledge in the water sector. Marissa has more than 10 years of experience in international development policy. She holds a Master of Public Management degree from the University of Maryland and a BA from Texas A&M University.

Kaida Liang

Project Coordinator Crystal works closely with research teams to manage outputs and deliverables. She also liaises with UNC fiscal and administrative offices. Crystal has a Bachelor of Science in Public Health in Environmental Health Science from UNC.

MEL Project Manager Kaida is the project manager for the monitoring, evaluation and learning project in partnership with the Conrad N. Hilton Foundation. Kaida has extensive international program and project management experience specializing in water, sanitation and hygiene, and humanitarian emergencies. She holds a Master of Public Health from UNC, with a focus on environmental health and water.

Chris Cline

IT Associate Chris provides web and software support, including running Water Institute-hosted websites and managing our online conference registration and abstract submission. He is completing his Master of Information Science at UNC’s School of Information and Library Science. Hannah Leker

Research Support

Hannah assists the Director of Research with identifying and evaluating new research funding opportunities. She has a Bachelor of Science in Public Health in Environmental Health Science from UNC. Ashley R. Williams

Research Associate

Ashley works on projects on improving the regulation, monitoring and quality of the packed water Industry in Sierra Leone, and on the public health and social benefits of at-house water supplies. She completed her master’s degree in environmental engineering at UNC.

Katie Donohue

Public Relations and Partnerships Coordinator Katie develops partnerships between The Water Institute and researchers, foundations, corporations and alumni, and promotes work coming out of the Institute. She has a Master of Public Health and Global Health certificate from UNC, and a BA from the University of Mary Washington.


Crystal Ki

Enelda Butler

Communications Associate Enelda develops content for the newsletter and website, supports Water Institute conferences, and works with campus and external partners on communications activities. She has a MA in Journalism and Mass Communication from UNC, and a BA from the University of Alabama.

Ryan Cronk

Research Associate Ryan researches monitoring of access to drinking water beyond households and assessing the safety of improved water sources in less-developed countries. He has a master’s degree in environmental engineering from UNC. Ryan Rowe

Patty Chuang Margo Ginsberg Jessica Izquierdo Denise Johnson Joe LoBuglio Ben Mann Julia Mendenhall Julie Moushon

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Knowledge Manager Ryan works on knowledge and information management with our projects to identify, characterize, distribute and share lessons learned and insights. He has nearly 10 years of experience working with governments, researchers, nonprofits and private sector. Ryan holds an MPH from UNC, an MBA from York University and a Bachelor of Commerce from Concordia University.

We are also grateful to all of our past staff members, who contributed to The Water Institute’s first three years:


Post-doctoral Research Associates Urooj Amjad

Mike Fisher

Urooj examines how societies manage water by analyzing processes and relationships within organizations, and between institutions. Her most recent research integrates water, food and energy in emerging and more established economies, exploring how local and global boundaries are more entangled, and how institutional activities of public, private and civil society are overlapping.

Mike’s current work focuses on leveraging monitoring, evaluation and learning to maximize the impact of WaSH interventions. His research and fieldwork experiences have included work on developing, implementing and evaluating technologies for low-cost water treatment and safe water access spanning rural and urban developing country settings. Fernanda Dalcanale

Georgia Kayser

Georgia’s research lies at the nexus of global health policy studies and development economics. She studies how development policies achieve their goals through empirical research. She has also studied the impact of international water and sanitation development policies, the efficacy of drinking water innovations and the impact of transboundary watershed agreements. Jeanne Luh

Jeanne’s work focuses on the development of an index to measure progress in the realization of the human right to water and the recalibration of the Millennium Development Goal targets for safe water and sanitation. She is also assessing climate change vulnerability to extreme weather events and the implementation of Water Safety Plans in North Carolina.

Fernanda investigated how information is disseminated in the WaSH sector and its effects on decision-making. She collaborated on several projects involving knowledge management, dissemination and information systems.* Mark Elliott

Mark’s projects at The Water Institute focused largely on climate change adaptation in WaSH, Water Safety Plans and small water supplies in resource poor settings. He is now a professor at the University of Alabama.* *Former post-doctoral research fellow

Visiting Fellows

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Robert Bain

Dr. Eugene Cole

Andrea Perez Vidal

Rob’s work with The Water Institute included developing indicators for global monitoring of urban water and sanitation. He also analyzed aid-supported policy innovations and technologies aimed at improving safe drinking water and sanitation systems in low- and middle-income countries and the investment required to achieve and sustain global access.

Gene is a professor of Environmental Health Sciences at Brigham Young University. As a visiting fellow at The Water Institute, he was instrumental in the development of our distance learning course on Water Safety Plans.

Andrea’s work with The Water Institute involved the development and distribution of a survey on Water Safety Plan adoption, development and implementation in Latin America, and a peer review of a large risk database for small water systems, for Health Canada and the WHO.

Maura Allaire

Shadi Eskaf

Kyle Onda

PhD candidate Environmental Sciences and Engineering Focus: Urban water and sanitation, water security

PhD candidate Environmental Sciences and Engineering Focus: water and wastewater rates and rate-setting, residential water consumption

MSPH and MCRP candidate Environmental Sciences and Engineering and City and Regional Planning Focus: Reducing risk of contamination in water distributions systems and plumbing

Rachel Baum

MS candidate Environmental Sciences and Engineering Focus: Measuring progress on the human right to water and sanitation Annalise Blum

PhD candidate Environmental Sciences and Engineering Focus: water, sanitation, policy, climate change Jonny Crocker

PhD candidate Environmental Sciences and Engineering Focus: Community-led total sanitation Jordan Deuink

BSPH Candidate Health Policy and Management Focus: Creating a decision support tool for rural water and sanitation projects Nicholas Defelice

Kristen Downs

PhD candidate Environmental Sciences and Engineering Focus: Sustainability of rural water supply, monitoring for sustainability, geographic equity in planning and implementing water supply

MSEE candidate Environmental Sciences and Engineering Focus: Creating a decision support tool for rural water and sanitation projects

Alycia Overbo

David Fuente

Stefanie Schwemlein

PhD candidate City and Regional Planning Focus: Drinking water and sanitation in lessdeveloped countries, infrastructure finance and planning

BSPH Candidate Environmental Sciences and Engineering Focus: WaSH program sustainability, school WaSH systems

Sarah Hatcher

PhD candidate Environmental Sciences and Engineering Focus: Sanitation and hygiene behavior, applied qualitative research methods, sanitation technologies

PhD candidate Environmental Sciences and Engineering Focus: The impacts of industrial animal production on microbial water quality and environmental health

MSPH Candidate Environmental Sciences and Engineering Focus: Water availability, water usage, sustainability

Vidya Venkataramanan

Caroline Kostyla

MS candidate Environmental Sciences and Engineering Focus: Clean water in the developing world Camille Morgan

BSPH Candidate Biostatistics Focus: Monitoring WaSH program sustainability Edema Ojomo

PhD candidate Environmental Sciences and Engineering Focus: Creating an enabling environment for WaSH

*Students affiliated with The Water Institute are registered students at UNC and have active interest in WaSH-health-environment linkages. They pursue research in one or more of The Water Institute-defined focus areas, and often work alongside advisers who are themselves affiliated to The Water Institute.

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PhD candidate Environmental Sciences and Engineering Focus: Probability of harm due to environmental contamination, assessing disparities in water service

Ben Foster

c u r r e nt w a t e r in s tit u t e a f f ili a t e d s t u d e nt s

Current Water Institute Affiliated Students* (as of Fall 2013)


Water Institute Alumni Andrew Armstrong

Christian Jasper (Hughes)

Ashley Williams (Rhoderick)

2011, MSEE Environmental Sciences and Engineering Technical Report: Characterization of ionic copper for disinfection of stored drinking water

2011, MPH Environmental Sciences and Engineering Technical Report: The availability of water and sanitation facilities in schools contributing to health and educational outcomes: A systematic review

2013, MSEE Environmental Sciences and Engineering Technical Report: Examining the relationship between distance and water quantity: A systematic review and multi-country field study

Tam Le

2012, MPH Health Behavior and Health Education Thesis: NC Latina BEAUTY Salon Project: Formative research, design, implementation and evaluation of a salon-based health promotion pilot program in a Latino salon in the NC Triangle area

Ovik Banerjee

2012, BS Environmental Studies, Biology Thesis: Evaluating country level population vulnerabilities to water access due to climate related hazards using high spatial resolution method

Biology, Romance Languages Focus: Dry sanitation technologies

Rachel Baum

Grant Ligon

2012, BSPH Health Policy and Management Thesis: Measuring the human right to water: Developing quantitative indicators through using existing data sets for the equity component of the human right to water

2011, MSPH Environmental Sciences and Engineering Thesis: Waterborne disease outbreaks: A systematic review of the health effects of drinking water system failures

Ryan Cronk

2011, MS

2013, MS

Environmental Sciences and Engineering Thesis: Specifications and design criteria for a packaging sanitation solution for peri-urban areas in developing countries

Environmental Sciences and Engineering Thesis: Drinking water, sanitation and hygiene beyond the household: A review and case study of Ghana Kang Chang

2011, MS Environmental Sciences and Engineering Thesis: Water Safety Plan cost analysis: Explanation building with case studies in the Western Pacific region T he W ater I nstitute at U N C


2012, BS

Elizabeth Morris

Edema Ojomo

2011, MSEE Environmental Sciences and Engineering Thesis: Climate adaptation preparedness in developing countries: A study of 21 countries and knowledge, attitudes and practices studies in Akwa Ibom and Lagos States in Nigeria

Jonny Crocker

2011, MSEE Environmental Sciences and Engineering Technical report: Characterization and cost-analysis of drinking water quality monitoring in India and Jordan

Jennifer Platt

2011, DrPH Health Leadership, Health Policy and Management Dissertation: Accelerating sanitation: A mixed-methods assessment of the health ministry’s role in developing countries

Ryan Rowe

Jennifer Shields (Gentry)

2012, PhD Environmental Sciences and Engineering Dissertation: Utilization of microbial source-tracking markers to inform targeted remediation and predict potential pathogens in the Cape Fear Watershed Hannah Spring

2012, MSPH Environmental Sciences and Engineering Thesis: Drinking water and health: Stakeholders’ risk perceptions Alexander Yerg

2013, MSPH Environmental Sciences and Engineering Technical Report: Modeling and forecasting drinking water and sanitation access: A new approach

Michael Aitken*

Gregory Characklis*

William Gray

Environmental Sciences and Engineering

Environmental Sciences and Engineering

Environmental Sciences and Engineering

Professor Aitken’s research focuses on the application of microbial processes to the biodegradation of organic pollutants and to waste treatment problems. He also conducted research to evaluate the inactivation of microbial pathogens during wastewater sludge treatment.

Associate Professor Characklis’ primary research interests involve integrated planning of water supply and treatment strategies through the consideration of both engineering and economic criteria.

Professor Gray’s interests include physics-based modeling of environmental processes.

Myron Cohen* Richard Andrews*

Public Policy

Professor Andrews’ research focuses on the effectiveness and other consequences of environmental laws and policies in promoting or creating barriers to a more environmentally sustainable future. Lawrence Band*

Geography; Director of UNC’s Institute of the Environment

Voit Gilmore Distinguished Professor Band’s research focuses primarily on the structure, function and dynamics of watersheds, with an emphasis on the quantity and quality of surface water and ecosystem cycling of carbon and nutrients. This work explicitly includes the actions of human individual and institutional behavior as part of the watershed ecosystem. Margaret E. Bentley*


Professor Bentley’s research focuses on women and infants’ nutrition, infant and young child feeding, behavioral research on sexually transmitted diseases, HIV, and community-based interventions for nutrition and health. She is an expert in both qualitative and quantitative research methods and the application of these for program development and evaluation.

UNC School of Medicine; Joint appointment in Epidemiology; Director of UNC Center for Infectious Diseases

J. Herbert Bate Distinguished Professor Cohen’s research focuses on transmission and prevention of transmission of STD pathogens, including HIV. Much of his work has been conducted at the research sites he and his group have developed in Lilongwe, Malawi and Beijing, China. Orlando Coronell*

Assistant Professor Castillo’s research includes coral physiological ecology, climate change, and conservation. He is on the steering committee for Water In Our World.

Associate Professor Konrad’s research explores the spatial and temporal patterns of atmospheric processes/ patterns and the multiple linkages of these processes/patterns to surface weather and climate variability. Rick Luettich

Marine Sciences; Director, Institute of Marine Sciences

Professor Luettich’s research deals broadly with modeling and measurement of circulation and transport in coastal waters. Suzanne Maman

Assistant Professor Coronell studies physicochemical processes for water purification, with an emphasis on membrane technologies.

Associate Professor Maman’s research interests include global health, health behavior, infectious diseases, sexually transmitted diseases, violence prevention and women’s health. She serves as a Technical Advisor the Conrad N. Hilton Foundation Monitoring, Evaluation and Learning Project.

Michael Emch


Professor Emch conducts medical geography/ spatial epidemiology research that uses geographic information systems, satellite remote sensing and spatial modeling techniques. Most of his research has been on infectious diseases in the developing world, including cholera, dysentery (shigellosis), visceral leishmaniasis (kala-azar), dengue fever, avian influenza, HIV, malaria and acute lower respiratory infection. Environmental Sciences and Engineering

Assistant Professor Fry’s research focuses on understanding how environmental exposures are associated with human disease with a particular interest in genomic and epigenomic perturbations.

Health Behavior

Benjamin Mason Meier*

Public Policy

Assistant Professor Meier’s research— at the intersection of international law, public policy and global health— examines the harmful effects of globalization on individual health status and national health systems. Cass Miller

Environmental Sciences and Engineering

Okun Distinguished Professor Miller’s research involves the study of complex, multiphase or multimedia environmental systems using theoretical, computational and experimental means.

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Marine Sciences


Environmental Sciences and Engineering

Rebecca Fry Karl Castillo

Chip Konrad*


UNC Faculty Members Working in WaSH


Rachel Noble*

Terry Rhodes

Howard Weinberg

Marine Sciences


Professor Noble’s research bridges environmental microbiology and marine microbial ecology. She has developed a range of rapid water quality test methods and studies the dynamics of microbial contaminants contributed through stormwater runoff to highpriority recreational and shellfish harvesting waters.

Professor Rhodes is the Senior Associate Dean for Fine Arts and Humanities. She is also the co-chair of the steering committee for the campus-wide theme Water In Our World.

Environmental Sciences and Engineering

Kavita Singh Ongechi

Maternal and Child Health

Research Assistant Professor Ongechi’s research interests are program evaluation of maternal and child health and HIV prevention programs, influence of gender measures on health outcomes and research focused on reaching vulnerable populations with interventions. She serves as a Technical Advisor for the Conrad N. Hilton Foundation Monitoring, Evaluation and Learning Project. Hans W. Paerl*

Marine Sciences

Kenan Distinguished Professor Paerl conducts research in microbially mediated nutrient cycling and primary production dynamics of aquatic ecosystems, environmental controls and management of harmful algal blooms. He assesses the causes/ consequences of manmade and climatic nutrient enrichment and hydrologic alterations of inland, estuarine and coastal waters. Tamlin Pavelsky

Geological Sciences

His research interests are focused on the intersections between hydrology, satellite remote sensing, and climate change. He is on the steering committee for Water In Our World. Rohit Ramaswamy

Public Health Leadership Program

T he W ater I nstitute at U N C


Associate Professor Ramaswamy’s research interests include methods and tools for implementation of global health programs, quality improvement of health systems, use of technology for workforce capacity building and monitoring and evaluation. He serves as the Learning Advisor for the Conrad N. Hilton Foundation Monitoring, Evaluation and Learning Project.

Marc Serre*

Environmental Sciences and Engineering

Associate Professor Weinberg’s research group develops analytical methods for evaluating the occurrence, fate and transport of chemicals that might compromise water quality and threaten public health. Stephen C. Whalen*

Associate Professor Serre is interested in the development of space/time statistical methods to model the distribution of environmental and health processes and their application in exposure mapping, disease mapping, environmental epidemiology and risk assessment.

Environmental Sciences and Engineering

Philip Singer*

Whisnant is the Gladys Hall Coates Professor of Public Law and Policy. His work focuses on environmental protection and natural resources management.

Environmental Sciences and Engineering

Professor Emeritus Singer’s research interests included aquatic chemistry and physical-chemical treatment processes, focusing primarily drinking water treatment. Gary Slade

School of Dentistry

Distinguished Professor Slade is the Director if the Oral Epidemiology PhD Program. His research focuses on drinking water fluoridation. Mark D. Sobsey*

Environmental Sciences and Engineering

Kenan Distinguished Professor Sobsey studies human exposure to and health effects from pathogens in water, food and other environmental media to which people can become exposed in the developed and developing world. Jill Stewart*

Environmental Sciences and Engineering

Assistant Professor Stewart is developing novel techniques to detect and track pathogens in water. She is also interested in evaluating impacts of non-point source pollution, and the manner in which human activities can affect people’s exposure to microbial contaminants.

Associate Professor Whalen’s interests include nutrient cycling dynamics and productivity in aquatic and forested environments and agroecosystems. Richard Whisnant

School of Government

Dale Whittington*

Environmental Sciences and Engineering

Professor Whittington is an environmental and water resources economist with research interests in nonmarket valuation methods. His research focuses on the political economy of international rivers such as the Nile and the Ganges. He also works on water supply and sanitation policy issues in less developed countries.

*Participated in Water Institute activities Academic Years 2009-10 to 2012-13.

Articles in Peer-reviewed Journals Bain, Robert, Stephen W. Gundry, Jim A. Wright, Hong Yang, Steve Pedley, and Jamie K. Bartram. 2012. “Accounting for Water Quality in Monitoring Access to Safe Drinking Water as Part of the Millennium Development Goals: Lessons from Five Countries.” Bulletin of the World Health Organization 90 (3): 228-235.

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Bain, Robert, Jamie Bartram, Mark Elliott, Robert Matthews, Lanakila McMahan, Rosalind Tung, Patty Chuang, and Stephen Gundry. 2012. “A Summary Catalogue of Microbial Drinking Water Tests for Low and Medium Resource Settings.” International Journal of Environmental Research and Public Health 9 (5): 1609-1625. Bain, Robert, Jim Wright, Hong Yang, Steve Pedley, Stephen Gundry, and Jamie Bartram. 2012. “Improved But Not Necessarily Safe: Water Access and the Millennium Development Goals.” Global Water Forum Discussion Paper 1225. Bartram, Jamie, Katrina Charles, Barbara Evans, Lucinda OHanlon, Steve Pedley, and others. 2012. “Commentary on Communityled Total Sanitation and Human Rights: Should the Right to Community-wide Health Be Won at the Cost of Individual Rights?” Journal of Water and Health 10 (4): 499. Bartram, Jamie, Mark Elliott, and Patty Chuang. 2012. “Getting Wet, Clean and Healthy: Why Households Matter.” Lancet 380 (9837): 85. Bartram, Jamie and Sandy Cairncross. 2010. “Hygiene, Sanitation and Water: Forgotten Foundations of Health.” PLoS Medicine 7 (11): e1000367. Bartram, Jamie and Jennifer Platt. 2010. “How Health Professionals Can Leverage Health Gains from Improved Water, Sanitation and Hygiene Practices.” Perspectives in Public Health 130 (5): 215-221. Baum, Rachel, Jeanne Luh, and Jamie Bartram. 2013. “Sanitation: A Global Estimate of Sewerage Connections without Treatment and the Resulting Impact on MDG Progress.” Environmental Science & Technology 47 (4). Bradley, David and Jamie Bartram. 2013. “Domestic Water and Sanitation as Water Security: Monitoring, Concepts and Strategy.” Phil. Trans. R. Soc. A 371(2002). Brocklehurst, Clarissa and Jamie Bartram. 2010. “Swimming Upstream: Why Sanitation, Hygiene and Water are So Important to Mothers and Their Daughters.” Bulletin of the World Health Organization 88 (7): 482-482. Brown, Joe, Vo Thi Hien, Lanakila McMahan, Marion W. Jenkins, Lauren Thie, Kaida Liang, Erin Printy, and Mark D. Sobsey. 2013. “Relative Benefits of On-plot Water Supply Over Other ‘Improved’ Sources in Rural Vietnam.” Tropical Medicine & International Health 18 (1): 65-74. Cairncross, Sandy, Jamie Bartram, Oliver Cumming, and Clarissa Brocklehurst. 2010. “Hygiene, Sanitation and Water: What Needs To Be Done?” PLoS Medicine 7 (11): e1000365. Clasen, Thomas, Jamie Bartram, John Colford, Stephen Luby, Robert Quick, and Mark Sobsey. 2009. “Comment on Household Water Treatment in Poor Populations: Is There Enough Evidence for Scaling Up Now?” Environmental Science & Technology 43 (14): 5542-5544. Gibson, Jacqueline MacDonald, Jens Thomsen, Frederic Launay, Elizabeth Harder, and Nicholas DeFelice. 2013. “Deaths and Medical Visits Attributable to Environmental Pollution in the United Arab Emirates.” PloS One 8 (3): e57536.

Gore, Fiona, John Fawell, and Jamie Bartram. 2010. “Too Much or Too Little? A Review of the Conundrum of Selenium.” Journal of Water and Health 8 (3): 405-416. Gunnarsdottir, Maria J., Sigurdur M. Gardarsson, Mark Elliott, Gudrun Sigmundsdottir, and Jamie Bartram. 2012. “Benefits of Water Safety Plans: Microbiology, Compliance, and Public Health.” Environmental Science & Technology 46 (14): 7782-7789. Gunnarsdottir, Maria, Sigurdur Gardarsson, and Jamie Bartram. 2012. “Icelandic Experience with Water Safety Plans.” Water Science and Technology 65 (2): 277-288. * This list includes works authored or co-authored by present or past staff, affiliated faculty and students of The Water Institute at UNC during the calendar years 2009, 2010, 2011, 2012 and 2013 (as of October).

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Godfrey, Sam, Pawan Labhasetwar, Tapas Chakma, Satish Wate, Aditya Swami, and Jamie Bartram. 2011. “Assessing and Managing Fluorosis Risk in Children and Adults in Rural Madhya Pradesh, India.” Journal of Water, Sanitation and Hygiene for Development 1 (2): 136-143.


Howard, Guy, Katrina Charles, Kathy Pond, Anca Brookshaw, Rifat Hossain, and Jamie Bartram. 2010. “Securing 20/20 Vision for 2030: Climate Change and Ensuring Resilience in Water and Sanitation Services.” Journal of Water and Climate Change 1 (1): 2-16. Hunter, Paul R., Jamie Bartram, and Sandy Cairncross. 2012. “Comment on Randomized Intervention Study of Solar Disinfection of Drinking Water in the Prevention of Dysentery in Kenyan Children Aged Under 5 Years.” Environmental Science & Technology 46 (5): 3035. Itoh, Sadahiko, Bruce A. Gordon, Philip Callan, and Jamie Bartram. 2011. “Regulations and Perspectives on Disinfection Byproducts: Importance of Estimating Overall Toxicity.” Aqua- Journal of Water Supply: Research and Technology 60 (5): 261-274. Jasper, Christian, Thanh-Tam Le, and Jamie Bartram. 2012. “Water and Sanitation in Schools: A Systematic Review of the Health and Educational Outcomes.” International Journal of Environmental Research and Public Health 9 (8): 2772-2787. Kayser, Georgia, Patrick Moriarty, Catarina Fonseca, and Jamie Bartram. 2013. “Domestic Water Service Delivery Indicators and Frameworks for Monitoring, Evaluation, Policy and Planning: A Review.” Int. J. Environ. Res. Public Health 10: 4812-4835. Kosinski, Karen, Michael Adjei, Kwabena Bosompem, Jonathan Crocker, John Durant, Dickson Osabutey, Jeanine Plummer, Miguel Stadecker, Anjuli Wagner, Mark Woodin et al. 2012. “Effective Control of Schistosoma Haematobium Infection in a Ghanaian Community Following Installation of a Water Recreation Area.” PLoS Neglected Tropical Diseases 6 (7): 1709. Kosinski, Karen , Michael Adjei, Kwabena Bosompem, Jonathan Crocker, John Durant, Dickson Osabutey, Jeanine Plummer, Miguel Stadecker, Anjuli Wagner, Mark Woodin et al. 2011. “A Novel Community-based Water Recreation Area for Schistosomiasis Control in Rural Ghana.” Journal of Water, Sanitation and Hygiene for Development 1 (4): 259-268. Marks, Sara J., Kyle Onda, and Jennifer Davis. 2013. “Does Sense of Ownership Matter for Rural Water System Sustainability? Evidence from Kenya.” Journal of Water, Sanitation and Hygiene for Development 3 (2): 122-133. Meier, Benjamin, Georgia Kayser, Urooj Amjad, Jocelyn Getgen Kestenbaum, and Jamie Bartram. 2013. “Examining the Practice of Developing Human Rights Indicators to Facilitate Accountability for the Human Right to Water and Sanitation.” Journal of Human Rights Practice. Meier, Benjamin, Georgia Kayser, Urooj Amjad, and Jamie Bartram. 2013. “Implementing an Evolving Human Right through Water and Sanitation Policy.” Water Policy 15 (1): 116-133. Montgomery, Maggie A. and Jamie Bartram. 2010. “Short-sightedness in Sight-saving: Half a Strategy Will Not Eliminate Blinding Trachoma.” Bulletin of the World Health Organization 88 (2): 82-82. Onda, Kyle, Jonny Crocker, Georgia Kayser and Jamie Bartram. 2013. “Country Clustering Applied to the Water and Sanitation Sector: A New Tool with Potential Applications in Research and Policy.” International Journal of Hygiene and Environmental Health. Doi:10.1016/j.ijheh.2013.07.017. Onda, Kyle, Joe LoBuglio, and Jamie Bartram. 2012. “Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress.” International Journal of Environmental Research and Public Health 9 (3): 880-894. Peletz, Rachel, Thomas Mahin, Mark Elliott, Margaret Montgomery, and Thomas Clasen. 2013. “Preventing Cryptosporidiosis: The Need for Safe Drinking Water.” Bulletin of the World Health Organization 91 (4): 238-238a. Peletz, Rachel, Thomas Mahin, Mark Elliot, Mamie Sackey Harris, Ka Seen Chan, Myron Cohen, Jamie Bartram and Thomas Clasen. 2013. “Water, Sanitation, and Hygiene Interventions to Improve Health Among People Living With HIV/AIDS: A Systematic Review.” AIDS, 27. Rahman, Zarah, Jonny Crocker, Kang Chang, Ranjiv Khush, and Jamie Bartram. 2011. “A Comparative Assessment of Institutional Frameworks for Managing Drinking Water Quality.” Journal of Water, Sanitation and Hygiene for Development 1 (4): 242-258. Sobsey, Mark D., Christine E. Stauber, Lisa M. Casanova, Joseph M. Brown, and Mark A. Elliott. 2008. “Response to Comment on ‘Point of Sse Household Drinking Water Filtration: A Practical, Effective Solution for Providing Sustained Access to Safe Drinking Water in the Developing World.’” Environmental Science & Technology 43 (3): 970-971.

T he W ater I nstitute at U N C


Stauber, Christine E., Byron Kominek, Kaida R. Liang, Mumuni K. Osman, and Mark D. Sobsey. 2012. “Evaluation of the Impact of the Plastic BioSand Filter on Health and Drinking Water Quality in Rural Tamale, Ghana.” International Journal of Environmental Research and Public Health 9 (11): 3806-3823. Yang, Hong, Jim A. Wright, Robert ES Bain, Steve Pedley, John Elliott, and Stephen W. Gundry. 2013. “Accuracy of the H 2 S Test: A Systematic Review of the Influence of Bacterial Density and Sample Volume.” Journal of Water and Health 11 (2): 173-185. Yang, Hong, Rob Bain, Jamie Bartram, Stephen Gundry, Steve Pedley, and James Wright. 2013. “Water Safety, Equity and Human Rights: Differences in Access to Safe Drinking-water between Rich and Poor Households.” Environmental Science & Technology 47 (3): 1222-1230.

Bartram, Jamie and Barbara Wallace. 2011. “Water + Health = Life: Savvy Water Management Saves Lives.” Chap. 3, In Global Water Issues, edited by Duncan MacInnes, 45-51. Washington, D.C.: Bureau of International Information Programs, United States Department of State. B o o k s Au t h o r e d o r E d i t e d Cunliffe, David, Jamie Bartram, Emmanuel Briand, Yves Chartier, Jeni Colbourne, David Drury, John Lee, Benedikt Schaefer, and Susanne Surman-Lee, eds. 2011. Water Safety in Buildings: World Health Organization.

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B o o k C h ap t e r s Au t h o r e d o r C o -au t h o r e d

Dufour, Alfred, Jamie Bartram, Robert Bos, and Victor Gannon. 2012. Animal Waste, Water Quality and Human Health. International Water Association: IWA Publishing. Elliott, Mark, Andrew Armstrong, Joe Lobuglio, and Jamie Bartram. 2011. T. De Lopez (Ed.). Technologies for Climate Change Adaptation—The Water Sector. Roskilde: UNEP Risoe Centre. Rees, Gareth, Kathy Pond, and Jamie Bartram. 2010. Safe Management of Shellfish and Harvest Waters. International Water Association: IWA Publishing. I n v i t e d P r e s e n tat i o n s Bartram, Jamie. 2012. “Global Monitoring of Water Safety.” The Hague, Netherlands, Invited Plenary Presentation at WHO/UNICEF Consultation on the Formulation of Post-2015 Global WASH Goals, Targets and Indicators, December 3-5, 2012. Bartram, Jamie. 2012. “University Day 2012 Keynote Address.” Chapel Hill, NC, University of North Carolina at Chapel Hill, October 12, 2012. Bartram, Jamie. 2012. London, 2nd International Meeting of WHO/UNICEF Post-2015 Working Group on Water of JMP Process for Developing Enhanced Goals, Targets and Indicators for Global Monitoring of Water, Sanitation and Hygiene Beyond 2015, WaterAid, June 28-29, 2012. Bartram, Jamie. 2012. “Development of Targets and Monitoring for Post-2015 Global WaSH Monitoring.” Chateau de Penthes, Geneva, Presentation to WHO Expert meeting on sampling and statistical aspects of the rapid assessment of drinking water quality, June 18-19, 2012. Bartram, Jamie. 2012. “State of Water and Sanitation: How Secure is Water for People.” Oxford, UK, Plenary Keynote at University of Oxford International Security Conference: Water Security, Risk and Society, St Hugh’s College, April 16-18, 2012. Bartram, Jamie. 2012. “Water Security: WaSH Goals, Targets and Metrics for the Next 25 Years.” Oxford, UK, University of Oxford International Security Conference: Water Security, Risk and Society, St Hugh’s College, April 16-18, 2012. Bartram, Jamie. 2012. “Health Sciences Perspective.” London, Keynote presentation at session 2 (opportunities and challenges) of the Wellcome Foundation Workshop on Impact of Global Environmental Change on Water and Human Health: Building Integrated Research and Translation to Understand & Address the Challenges with an emphasis on Low-middle Income Countries (LMICs). March 21-23, 2012. Bartram, Jamie. 2012. “Lessons Learned from Monitoring Progress Towards the MDG 7c Target for Water Supply and Sanitation, and the Implications for Future Targets and Monitoring.” Marseilles, Presentation to first working group meeting on Post-2015 Water Targets, March, 2012. Bartram, Jamie. 2011. “Building Communities: The Changing Principles of International Development - What Does Sustainability Mean and How Do We Achieve it?” New Orleans, USA, First keynote address. Water and Sanitation Rotarian Action Group World Water Summit IV, May 20, 2011.

Bartram, Jamie. 2011. “Water Sanitation and Hygiene in Developing Countries.” Cincinnati, OH, Invited Opening General Session Keynote speaker Water Environment Federation Disinfection Conference, April 10-12, 2011. Bartram, Jamie. 2010. “International Relations in Practice: How a Specialized Agency such as WHO Collaborates with Government Institutions, Universities, Medical Schools, NGOs, National Research Institutions to Achieve its Core Functions.” John Knox Centre, Geneva, Switzerland, Invited presentation at Syracuse University summer course on International Relations, July 14, 2010.

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Bartram, Jamie. 2011. “Lessons Learned from Monitoring Progress Towards the MDG 7c Target for Water Supply and Sanitation, and the Implications for Future Targets and Monitoring Drinking Water and Sanitation.” Berlin, Germany, Invited presentation at the First Consultation on Developing Post-2015 Indicators for Monitoring, World Health Organization and UNICEF, May 4, 2011.


Bartram, Jamie. 2010. “How to Design Water Projects to Meet WHO’s Water Quality Standards by Incorporating Monitoring and Evaluation into Projects.” Montreal, Canada, Invited workshop speaker and facilitator Rotary International ‘Water and Sanitation Rotarian Action Group’ (WASRAG) World Water Summit III, June 19, 2010. Bartram, Jamie. 2010. “Drinking Water and Sanitation -- What Works?” New York, NY, Invited presentation to UN General Assembly ‘MDG Summit’ interactive session with academia on MDGs; participant in discussions with delegations as panelist, April 8, 2010. Bartram, Jamie. 2010. “Session Chair of the Benefits of Water Supply and Sanitation Policies, Including Making an Introductory Presentation at International Expert Workshop on Water Economics and Financing.” Paris, France. Organization for Economic Cooperation and Development, March 15-17, 2010. Elliott, Mark. 2011. “Climate Change and Water.” Washington, D.C., Invited presentation at World Water Day Learning Forum, WASH Advocacy Initiative and Center for Strategic and International Studies, March 21, 2011. Kayser, Georgia. 2012. “Manteniendo Limpia El Agua Para Consumo Humano, Evaluación De Soluciones Sostenibles.” Dominican Republic, ‘Más allá de la infraestructura, integrando la Higiene en las Políticas Publicas de Agua y Saneamiento en América Latina, The Water and Sanitation Program, The World Bank, 2012. Kayser, Georgia. 2012. “Water Wisdom: Developing Local-Global Capacities in Managing Water.” Chapel Hill, NC, Public Policy, University of North Carolina, 2012. Rowe, Ryan. 2013. “Improving Water Quality at Home: A New Toolkit for Household Water Treatment and Safe Storage.” Lisbon, Portugal, Invited presentation at Water and Sanitation Rotarian Action Group World Water Summit, June 21, 2013. Rowe, Ryan. 2013. “Integrating Safe Water and Maternal Health in Malawi.” Accra, Ghana, Invited presentation and workshop facilitator at WHO/UNICEF Workshop of Environmental Health Interventions in West Africa, May 6, 2013. Rowe, Ryan. 2013. “Current Status of HWTS.” Lilongwe, Malawi, Invited presentation and workshop facilitator at Ministry of Health Stakeholders Consultative Workshop on Household Water Treatment and Safe Storage, April 18, 2013. Rowe, Ryan. 2012. “Household Water Network: Communications for Learning.” Maputo, Mozambique, Invited presentation at WHO/UNICEF Workshop of Environmental Health Interventions in West Africa, June 22, 2013. Published Conference Proceedings Au-Yeung, H., D. Kay, D. Thomas, M. Figueras, M. Vargha, M. Kadar, P. Hunter, J. Bartram, and R. Salmon. 2010. “Adverse Health Effects of Recreational Bathing: A Meta-Analysis of Randomized Exposure Trials in Four European Countries.” Glasgow, Scotland, Submitted to Five Nations Conference, May 18-19, 2010. Elliott, M., F. DiGano, A. Fabiszewski, P. Chuang, L. Clark, A. Wang, and M. Sobsey. 2009. “The Effect of Idle Time on Reduction of Viruses in an Intermittently Operated, Household-scale Slow Sand Filter.” Atlanta, GA, Submitted to the Disinfection 2009 Conference, Water Environment Federation, February 28 - March 3, 2009. Stauber, C., M. Elliott, F. DiGano, and M. Sobsey. 2009. “Performance Comparison of the Biosand Filter in Laboratory Studies and a Longitudinal Field Study in Bonao, Dominican Republic.” Atlanta, GA, Submitted to the Disinfection 2009 Conference, Water Environment Federation, February 28 - March 3, 2009.

T he W ater I nstitute at U N C





F unding S ource D istribution 2 0 1 0 - 1 1 to 2 0 1 2 - 1 3



Foreign Government Private UN/IGO NGO-US NGO-Non-US Foundations

21% 21%

1,800 A N N UA L E x penditure by F U N C T I O N area Expenditures ($1000s)

Core Teaching and Learning Networking and Partnerships Knowledge and Information Management Research

1,600 1,400 1,200 1,000 800 600 400 200 0 2011-2012



Annual expenditures follow the July-June fiscal year timeframe. For example, the year 2010-11 spanned July 2010 until June 2011. Core expenditures are primarily personnel and overlap with other categories, as individual responsibilities span function areas. Figures include amounts reported in accounts of the Department of Environmental Sciences and Engineering, overall expenditures for Water and Health Conferences and salary estimates for employees from other business units in proportion to their contribution to Water Institute activities.

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The Water Institute at UNC: The Water Institute was founded in 2010 with the mission to provide global academic leadership for economically, environmentally, socially and technically sustainable management of water, sanitation and hygiene for equitable health and human development; and to be a vibrant, interdisciplinary center that unites faculty, students and partners from North Carolina and from across developed and developing nations worldwide. Our researchers have produced more than 60 publications in important WaSH policy and practice arenas, including monitoring, evaluation and learning, governance, sanitation, water scarcity and climate change, and drinking water. In three years, our annual Water and Health Conference has become the most important meeting in North America of international WaSH, health and development thought-leaders. We are expanding our focus, with two additional conferences, Nexus 2014: Water, Food, Climate and Energy Conference and 2014 Water Microbiology Conference: Microbial Contaminants from Watersheds to Human Exposure. Through our teaching and learning efforts, we contribute to the courses, seminars and degree programs within the Gillings School of Global Public Health and elsewhere on campus. We respond to global needs by offering highly accessible professional training programs, such as our distant learning course on Water Safety Plans. In collaboration with IWA, we publish the Journal of Water, Sanitation and Hygiene for Development, a peer-reviewed journal devoted to the science, policy and practice of drinking water supply, sanitation and hygiene at local, national and international levels. Since the Institute’s inception, we have developed research partner­ ships with UNC faculty and departments, as well as governments, intergovernmental organizations, NGOs, the private sector, universities and other research institutes. We are a founding member of the US Water Partnership, on the steering committee for the Sanitation and Water for All Partnership, and provide communications support to the WHO International Network on Household Water Treatment and Safe Storage.

The Gillings School of Global Public Health The University of North Carolina at Chapel Hill Rosenau Hall, CB #7431 135 Dauer Drive Chapel Hill, NC 27599-7431 (919) 966-7302 www.waterinstitute.unc.edu LinkedIn: The Water Institute at UNC

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The Water Institute at UNC

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