NEPAL RED CROSS SOCIETY
NRCS AND ITS INTERVENTIONS IN WATSAN ANDDRINKING WATER QUALITY IMPROVEMENT

14 Dec 2010, Kathmandu
Umesh Dhakal
Executive Director

Presentation Outline
1.

Nepal Red Cross Society (NRCS) and its
involvement in drinking water & sanitation

2.

Contribution of NRCS in(a) arsenic contamination investigation(b) mitigation measures(c) health survey(d) capacity building(e) awareness raising etc.

Organizational capacity••••

National Headquarters
District Chapters
Sub-chapters and Co-operation Committees
Junior and Youth Red Cross Circles-175
1,3634,858

Total Organizational units- 6,297

Total Members- 1,019,779

NRCS’ engagement in WATSAN• Initiated Watsan activities in 1980
• NRCS Primary Health Care and Drinking Water
Project (PHC/DWP) was first started in 1983 withsupport by Japanese Red Cross and Unicef from1985• A new approach- Drinking water and Sanitation
Programme was introduced in July 1993
• with more emphasis on software approach• Increased women participation• Community Based Model
48 districts reached alreadyNRCS- Water Quality (Arsenic) Focused Project
2000-2003: Based on the findings, the program wasextended & renamed as ‘Drinking Water Quality
Improvement Program’ (DWQIP)
 more than 11,000 tube well water samples tested
 Health survey on arsenic-induced adverse effects
 Mitigation measures
 Awareness programs

NRCS-Water…..
2003-2005: The program was extended as ‘Drinking Water
Quality Improvement Program- Follow up’ (DWQIP) Re-examination of identified patients Provision of appropriate alternative options
 Monitoring of the options
 Capacity building
2004/05-2010: A new approach-Blanket Arsenic Test andmitigation initiated .NRCS adopted the approach withsupport of JRCS, DWSS,UN Habitat and Unicef.
 All private public water source tested
 Arsenic Information Management System Mitigation strategy and plan developed Mitigation and Capacity buildingProgram Implementation Flow
Nepal Red Cross Society
Head Quarters
Community Development Department
DWQIP

District Chapters
Arsenic Information Centers

Sub District Chapters
In VDCs¥VDC

Program Implementation
VDC¥Community

NRCS in Arsenic Mitigation in Nepal• Investigated the situation of arsenic contamination inground water of Nepal in large scale.
• Played a role in the formation of National Arsenic
Steering Committee (NASC) and working as an active
member of it.
• Assisted to formulate the guidelines for NASC
• Conducted mitigation program in large scale in arsenic
affected areas within the NRCS program areas.
• Conducted research on different types of arsenic
mitigation options in Nepalese context.

NRCS …. contd• Prepared map on Arsenic based GPS Data.
• Conducted health surveys on arsenicosis cases• Actively involved in Blanket Testing Program forarsenic contamination in Bara, Parsa andRautahat districts.
• Regular monitoring of arsenic contaminationlevels• Development and distribution of IEC materials.
• Capacity building (trainings to Health workers,maintenance of provided options etc)

Major Activities of Quality
Improvement• Arsenic Testing of all the installed Tube wells• Testing of bacteria, Iron and other parameters• Health Impact Study• Provision of Mitigation Options• Awareness Raising Campaign• Sharing the experiences with interestedagencies• Establishment of Arsenic Information Center(AIC) at Districts.

Sampling and Testing of Tube Well Water For Arsenic
1. All the Samples werecollected and tested by AAS.
2. For the monitoring, ENPHOArsenic Test Kit was used.

Health Impact Study in the Arsenic
affected Areas of Nepal

Study by: Senior Health Advisor

Study Design for Health Surveys
Study Areas (Four District)

Arsenicosis Patients
Pre-Test
Water Analysis
Questionnaire
SurveyClinicalExamination
Hair¥Urine
Analysis

MIT
I
GA
T
I
ON

Post-Test
O
PT
IO
N

Water Analysis
Questionnaire
SurveyClinicalExamination
Hair¥Urine
Analysis

Methodology used for Health survey• Tube wells with arsenic contamination > 50 ppb wereselected for Health survey• Information on the recipients were taken with the help ofstructured questionnaires• Trained Health workers who conducted the survey also
observed the population and collected hair/nail and urine
samples of the symptomatic persons•Hair/nail and urine samples were brought to ENPHO lab foranalysis•Final confirmation of the symptomatic patients was done by
Medical doctor/Senior Health Adviser . In addition thesepatients were again confirmed by Doctors from Bangladesh)Findings of Health Study• 15,131 individuals were examined. The overall
Prevalence rate was 2.9%.
• Prevalence increased by age• Prevalence rate is higher in the age group of 50years and above.
• Most of the patients were in the early stages ofarsenicosis symptoms like melanosis and keratosis• With the use of arsenic safe options provided
under NRCS program, health condition of most of
the patients (79%) have improved.

Alternative Water Sources Provided• Safe (Arsenic Free) Tube wells-advise provided.
• Improved Dug well (Dug well with good sanitary
Protection)• Arsenic Iron Removal Plant (AIRP)• Installation of Tube wells in safe aquifer• Household level Arsenic Removal Filters (TwoGagri System, Three Kolshi System, Arsenic
Kanchan Filter)

Marking Tube-wellDug well as an Alternative Option

Arsenic Content in Dug Wells
Figure: Arsenic levels in Improved dug Well

54
60
40
No. of Dug
wells

320

100
0

1-10

11-50

>50

Aersenic level (ppb)

Arsenic Iron Removal Plant (Nawalparasi)

Two Gagri Filter
Chemical packet contains:• Ferric chloride (coagulant)• Sodium hypochlorite (oxidant)• Charcoal (adsorbent)

TreatedWater

Raw Water

Mixing & Settling

Filtration (ceramic filter)

Three-Gagri System
Arsenic
contaminated

Brick chips 1.0 kg,
iron nail 2.5 kg andcoarse sand 2 kg
Brick chips 1kg
charcoal 1 kg &Fine sand 2kg
Arsenic Free
water

Treatment Process: Absorption, Precipitation, and Filtration

Arsenic Kanchan Filter

Lessons Learnt• Arsenic level fluctuate• Need regular monitoring in future• Needs to provide safe water option before
recommending to stop/shut down existing
contaminated tube well
• Need strong motivational program tochange people’s perception/behaviour• Mitigation program should not run agency
wise approachLessons Learnt …... contd• Kanchan Arsenic Filter (KAF) is found tobe the most effective arsenic removal
option among other filters• While conducting health survey, individualwith basic training on diagnosis issufficient for patient screening