Guidelines for the Surveillance and Control of Drinking Water Quality

OPS/CEPIS/PUB/02.80 Original: Spanish

Pan American Center for Sanitary Engineering and Environmental Sciences Health and Environment Division Pan American Health Organization Pan American Sanitary Bureau, Regional Office of the World Health Organization

GUIDELINES FOR THE SURVEILLANCE AND CONTROL OF DRINKING WATER QUALITY

Ricardo Rojas PAHO/CEPIS Advisor

With the sponsorship of the

United States Environmental Protection Agency

Lima, 2002

OPS/CEPIS/PUB/02.80 Original: Spanish

GUIDELINES FOR THE SURVEILLANCE AND CONTROL OF DRINKING WATER QUALITY

Ricardo Rojas PAHO/CEPIS Advisor

Lima, 2002

Pan American Center for Sanitary Engineering and Environmental Sciences, 2002

All rights reserved by the Pan American Center for Sanitary Engineering and Environmental Sciences, PAHO/CEPIS. The document can be abstracted, reproduced or translated, in part or in whole, without prior permission, but not for sale or for commercial purposes.

PAHO/CEPIS is a specialized agency of the Pan American Health Organization (PAHO/WHO).

Los Pinos 259, Lima, Peru P. O. Box 4337, Lima 100, Peru Phone: (511) 437 1077 Fax: (511) 437 8289 [email protected] http://www.cepis.ops-oms.org

CONTENTS

Page

Foreword ...... xiii

1. Conceptual Framework...... 1 1.1 Introduction...... 1 1.1.1 General...... 2 1.1.2 Nature of the Guidelines...... 3 1.1.3 Importance of the Quality of Drinking Water...... 4 1.1.4 Health Impact of Pathogenic Agents in the Water...... 4 1.1.5 Benefits of the Surveillance and Control of Water Quality...... 5 1.2 Background, Present Situation and Trends...... 6 1.3 General Concepts, Principles and Objectives ...... 7 1.3.1 Sanitary Surveillance of Drinking Water Quality...... 7 1.3.2 Control of Drinking Water Quality...... 8 1.3.3 Relationship between Sanitary Surveillance and Control of Water Quality 8 1.4 Legal Framework...... 10 1.5 Political and Institutional Framework, and Responsibilities ...... 12 1.6 Goals and Priorities...... 14 1.7 Regulatory Entities ...... 15 1.8 Citizen Participation ...... 16

2. Elements of Surveillance and Control...... 16 2.1 Basic Aspects...... 17 2.1.1 Physical-Chemical and Microbiological Evaluation ...... 17 2.1.2 Sanitary and Operational Inspection...... 25 2.1.3 Institutional Evaluation...... 26 2.2 Support Aspects ...... 26 2.2.1 Regulations and Standards ...... 26 2.2.2 Resources ...... 28 2.2.3 Training...... 32 2.2.4 Sanitary Education...... 33 2.2.5 Surveys ...... 35 2.3 Information ...... 36 2.3.1 Application of the Surveillance Information...... 36 2.3.2 Information Flow...... 37 2.3.3 Data Processing and Reports...... 39 2.4 Sanctions...... 42

3. Methodologies ...... 42 3.1 General ...... 42 3.1.1 Surveillance and Control Levels...... 42 3.1.2 Scope...... 44 3.1.3 Fields of Action ...... 46 3.2 Surveillance Plan ...... 48 3.2.1 Diagnosis...... 48

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3.2.2 The Plan ...... 49 3.2.3 Intervention Possibilities...... 51 3.2.4 Investments ...... 51 3.3 Water Quality Control in Urban Environments ...... 52 3.3.1 Planning ...... 52 3.3.2 Execution ...... 53 3.3.3 Data Processing and Reports...... 53 3.3.4 Corrective Measures...... 54 3.3.5 Preventive Measures...... 55 3.4 Water Quality Control in Rural Areas ...... 56 3.4.1 Introduction...... 56 3.4.2 Evaluation of Water Supply Services ...... 56 3.5 Surveillance...... 58 3.5.1 General...... 58 3.5.2 Validation of Data...... 58 3.5.3 Auditing ...... 59 3.5.4 Epidemiological Evaluation...... 59 3.5.5 Management of Information, Risk Investigation and Identification ...... 60 3.5.6 Follow-Up and Development...... 60 3.5.7 Periodic Reports...... 61

4. Bibliography ...... 62

List of Annexes

Annex 1 Frequencies of Sampling and Sanitary Inspection ...... 65 Annex 2 Information Required for Planning a Water Quality Control Program...... 71 Annex 3 Workshop Participants and Reviewers ...... 77

List of Tables

Table 1 Indicators for the Water Supply Service ...... 22 Table 2 Recommended Analytical Determinations ...... 22 Table 3 Proposed Levels Based on the Institutional Situation of the Country or Region...... 43 Table 4 Activities per Level of Intervention for the Surveillance or Control of Drinking Water...... 44 Table 5 Principal Requirements per Level of Intervention...... 45

Annex 1

Table 1 Frequencies of Sampling – Urban Systems. Physical-Chemical Parameters in the Distribution Network ...... 67 Table 2 Frequencies of Sampling – Urban Systems. Bacteriological Parameters in the Consumer Network...... 67 Table 3 Frequencies of Sampling – Urban Systems. Physical-Chemical A Parameters in the Outlets of the Treatment Plant, Groundwater Sources and Service Reservoirs...... 67

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Table 4 Frequencies of Sampling – Urban Systems. Physical-Chemical B Parameters in the Outlets of the Treatment Plant, Groundwater Sources and Service Reservoirs...... 68 Table 5 Frequencies of Sampling – Urban Systems. Bacteriological Parameters in the Outlets of the Treatment Plant, Groundwater Sources and Service Reservoirs...... 68 Table 6 Sampling Frequencies – Rural and Periurban Systems...... 69 Table 7 Frequency of Sanitary Inspections of the Treatment Plant and System Components 69

Annex 2

Table 1 Input Information. Components...... 73 Table 2 Supply Areas...... 74 Table 3 Standards Water Quality (Limits and Exceptions)...... 74 Table 4 Sampling Forms – Distribution Network...... 75 Table 5 Sampling Forms – Components...... 75 Table 6 Sampling Forms – Sources and Treatment Plants...... 76

List of Figures

Figure 1 Relationship between Control and Surveillance of Drinking Water Quality...... 11 Figure 2 Components of a Program of Control and Surveillance of Drinking Water Quality. 18 Figure 3 Example of the Analytical Capacity of the Laboratories of the Surveillance System 32 Figure 4 Use of Information Obtained from Control and Surveillance of Drinking Water Quality ...... 38 Figure 5 Information Flow–Supplier...... 40 Figure 6 Information Flow Surveillance of the Quality of the Water Supply Services...... 41 Figure 7 Processing Information ...... 55

APPENDICES

Appendix A National Program for the Surveillance and Quality Control of Drinking Water. Case Study: “The Country”...... 81

Introduction ...... 87

Chapter I...... 89

1. Rationale and Diagnosis ...... 89 1.1 The Country ...... 89 1.2 Distribution of Communities ...... 89 1.3 Population Growth...... 89 1.4 Situation of the Water Supply and Sanitation Services ...... 91

2. Health of the Population...... 91 2.1 Indicators ...... 91 2.2 Health Care Provided by the Public Health System ...... 91 2.3 Relative Importance of Communicable Diseases ...... 92

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3. Preventive Medicine in The Country ...... 95 3.1 Health Programs ...... 95 3.2 Investment...... 95 3.3 Public Health...... 95

4. Prevention of Diseases by Water Supply ...... 98 4.1 Impact of the Water Supply on Disease Reduction ...... 98

5. Surveillance...... 100 5.1 Surveillance of the Water Supply ...... 100 5.2 Surveillance in The Country ...... 101

6. Legal Framework and Organization...... 102

Chapter II ...... 103

7. National Program for the Surveillance and Quality Control of Drinking Water .. 103 7.1 General...... 103 7.2 Goals of the Surveillance Program ...... 103 7.3 Policies and Strategies ...... 104 7.4 Fields of Action ...... 104 7.5 Scope...... 105 7.6 Hoped-for Results...... 105 7.7 The Program’s Basic Lines of Action...... 108 7.8 Surveillance and Control Programs ...... 112 7.9 Operational Programs ...... 113 7.10 Support Programs ...... 114 7.11 Options for Implementing Surveillance Nationwide ...... 117

Chapter III ...... 119

8. Investment and Costs of Execution of the Surveillance and Control of Drinking Water and of the Water Supply Services ...... 119 8.1 Criteria for the Determination of Basic Costs...... 119 8.2 Cost of the Program ...... 127 8.3 Recommended Option ...... 134

9. Origin and Application of Funds...... 135 9.1 Sources of Funds...... 140 9.2 Use of the Funds ...... 140 9.3 Execution of the Surveillance Program ...... 141 9.4 Stages of Execution of the Program...... 143

List of Tables

Table 1 Total Population of the Country per Urban/Rural Area, Inhabitants, and Communities ...... 89 Table 2 Population Growth in The Country (in thousands)...... 90 Table 3 Projection of Communities in the Country ...... 90

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Table 4 Total Population and Coverage of Water Supply and Sanitation Services in the Year 2000 ...... 91 Table 5 Most Important Communicable Diseases in The Country...... 92 Table 6 Incidence and Relative Importance of the Top Ten Communicable Diseases in Peru (1997-1999)...... 93 Table 7 Communicable Diseases in the Country per State (1999) ...... 94 Table 8 Investment in Disease Control on the Part of the Health and Housing Sectors (percentages)...... 95 Table 9 Incidence of Communicable Diseases in the Country (1999)...... 96 Table 10 Impact of Means of Control on Human Health ...... 98 Table 11 Influence of Water on Human Health...... 98 Table 12 Estimated Reduction of Diseases by the Supply of Good Quality Water (East Africa)...... 99 Table 13 Estimated Reduction of Communicable Diseases by Environmental Control Programs and Others...... 100 Table 14 Analytical Determinations Stipulated in the Quality Standard...... 107 Table 15 Number of Determinations per Type of Locality (samples per year) ...... 110 Table 16 Analytical Determinations per Level of Surveillance...... 111 Table 17 Frequency of Bacteriological Sampling per Level (samples per year)...... 111 Table 18 Frequency of Physico-Chemical Sampling per Level...... 112 Table 19 Frequency of Sanitary Inspections per Level...... 112 Table 20 Present Situation of the Programs for the Control of Water ...... Quality and Options for Future Interventions...... 117 Table 21 Cost per Sample Taken ...... 119 Table 22 Number of Sanitary Inspections to be Effected per Day and per Inspector...... 120 Table 23 Cost of Determinations per Type of Laboratory...... 120 Table 24 Determinations and Cost per Physico-Chemical and Bacteriological Analysis .. 121 Table 25 Cost of Determinations per Size of Community and per Year ...... 122 Table 26 Cost of Analysis per Year and per Type of Locality (in US$) ...... 123 Table 27 Cost of Equipping Laboratories...... 125 Table 28 Cost of Staff...... 125 Table 29 Cost of Equipping Laboratories per Level of Intervention ...... 126 Table 30 Cost of Vehicles...... 127 Table 31 Projection of the Population to be Served with Water Supply Services...... 128 Table 32 Projection of Communities with Water Supply Services...... 128 Table 33 Number of Localities, Components per Locality and Total Components. Present Situation (Year 2001). Future Situation (Year 2010)...... 129 Table 34 Number of Samples to be Obtained for Water Quality Control Present Situation (Year 2001). Future Situation (Year 2010)...... 130 Table 35 Number of Sanitary Inspections. Present Situation (Year 2001) Future Situation (Year 2010) ...... 131 Table 36 Percentage of Participation of Institutions in the Drinking Water Quality Control Activities...... 132 Table 37 Percentage of Participation of the Surveillance Agency per Line of Action ...... 132 Table 38 Total Cost of the Program for the Surveillance and Control of Water Quality (2001 – 2010)...... 133 Table 39 Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001-2010 (in US$)...... 133

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Table 40 Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001-2010 (percentage)...... 134 Table 41 Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001-2010–Urban Areas ...... 134 Table 42 Cost of Analyses per Year and per Option (in US$)...... 135 Table 43 Cost of Sanitary Inspections per Year and per Option (in US$) ...... 136 Table 44 Cost of Sampling per Year and per Option...... 137 Table 45 Cost of Implementing Quality Control 2001–2010 (in US$) ...... 138 Table 46 Cost of Quality Surveillance 2001–2010 (in US$) ...... 139 Table 47 Functions of the Sanitary Authority...... 142 Table 48 Functions of the Regional Office for the Surveillance of Water Quality ...... 143

Appendix B Drinking Water Quality Control in Urban Areas Case Study: SEDACUSCO Water Company, City of Cuzco, Peru ...... 145

1. Background...... 151

2. Introduction...... 151

3. Rationale ...... 152

4. Goals and Objectives ...... 153 4.1 Main Goal...... 153 4.2 Specific Objectives...... 153

5. Strategy ...... 153

6. Indicators ...... 154 6.1 Water Quality ...... 154 6.2 Service Quality ...... 154 6.3 State of Repair of the Components of the Supply System...... 155

7. Methods and Procedures ...... 155 7.1 Prior Considerations ...... 155 7.2 Planning and Execution ...... 158 7.3 Quality Assurance of Data...... 159

Annexes

Annex 1 Responsibilities...... 161

Annex 2 Sampling Parameters and Frequencies ...... 165

1. Introduction...... 167 2. Physical, Chemical and Bacteriological Requirements, and Sampling Frequency 167 3. Chlorine Residual ...... 167

Annex 3 Components of the Water Supply System ...... 169

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Annex 4 Collection and Preservation of Samples ...... 175

1. Introduction...... 177 2. Containers and Volumes...... 178 3. Selection of Sampling Sites in the Network ...... 178 4. Sample Collection...... 181 5. Preservation ...... 183 6. Identification...... 184 7. Packing and Transportation ...... 185 8. Sampling Methods ...... 185 8.1 Sampling from Faucets ...... 185 8.2 Sampling in Open Wells or Storage Reservoirs...... 186

Annex 5 Training Program...... 189

Annex 6 Supply Areas ...... 193

Annex 7 Number of Samples...... 197

1. Scope...... 199 2. Number and Frequency of Samples...... 199 3. Cost...... 201

Annex 8 Data Collection Forms...... 203

Annex 9 Quality Assurance of Data ...... 207

1. Introduction...... 209 2. Number of Evaluations Conducted (1) ...... 209 3. Consistency of the Results (2) ...... 209 4. Number of Direct Supervisions (3)...... 210 5. Number of Verifications Conducted in the Field (4) ...... 210 6. Quality of Field Work (5) ...... 210

List of Tables

Annex 2

Table 1 Analytical Determinations and Number of Samples per Year...... 167 Table 2 Determination of Chlorine Residual...... 167

Annex 3

Table 1 Treatment Plants...... 171 Table 2 Surface Sources ...... 171 Table 3 Ground Sources. Wells ...... 171 Table 4 Ground Sources. Filtration Galleries ...... 171 Table 5 Ground Sources. Springs ...... 171 Table 6 Components. Storage Reservoirs...... 171

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Table 7 Components. Distribution Reservoirs...... 172 Table 8 Components. Pump Stations...... 173 Table 9 Components. Cisterns...... 173 Table 10 Components. Pressure Relief Boxes...... 173

Annex 4

Table 1 Containers and Type of Preservatives by Group of Determinations ...... 183 Table 2 Form for Water Sample Collection and Assessment of Service Quality Distribution Network...... 184

Annex 6

Table 1 Characteristics of the Supply Areas...... 195

Annex 7

Table 1 Number of Analytical Determinations per Year, SEDACUSCO...... 200 Table 2 Number of Chlorine Residual Determinations per Year, SEDACUSCO...... 200 Table 3 Cost of Analytical Determinations (in US$) ...... 201

Annex 8

Table 1 Distribution Network...... 205 Table 2 Components...... 206 Table 3 Treatment Plant...... 206

Annex 9

Form E-1 Quality Assurance of Data...... 212

List of Figures

Figure 1 Sampling Sites in Open Distribution ...... 179 Figure 2 Sampling Sites in Closed Distribution Systems ...... 180 Figure 3 Sampling Sites in Mixed Distribution Systems ...... 180

Appendix C Surveillance of the Quality of Rural Water Supply Services. Case Study: Cuzco, Peru ...... 213

1. Background...... 219

2. Introduction...... 219

3. Rationale ...... 220

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4. Goals and Objectives ...... 221 4.1 Main Goal ...... 221 4.2 Specific Objectives ...... 221

5. Strategy ...... 221

6. Indicators ...... 222 6.1 Water Quality...... 222 6.2 Quality of the Service ...... 223 6.3 State of Repair of the Components of the Supply System...... 223 6.4 Habits of Hygiene ...... 224 6.5 Management of the Supply Services...... 224 6.6 Diarrheal Diseases and Skin Infections ...... 225 6.7 Rating the Service...... 225

7. Methods and Procedures ...... 225 7.1 Prior Considerations ...... 225 7.2 Planning and Execution ...... 228 7.3 Quality Assurance of Data...... 229

8. Bibliography ...... 230

Annex 1 Responsibilities...... 231

Annex 2 Implementation and Complementation of Laboratories...... 235

Annex 3 Sampling Parameters and Frequencies ...... 239

1. Introduction...... 241 2. Physical, Chemical, and Bacteriological Requirements...... 241 3. Sampling Frequency ...... 241 4. Residual Chlorine...... 241 5. Quality of the Water Supply Service ...... 244

Annex 4 Assessment of the Water Supply Service (Miscellaneous Forms and Instructions for Filling Them Out)...... 245

Annex 5 Sample Collection and Preservation, and Reporting of Findings ...... 267

1. Introduction...... 269 2. Containers and Volumes ...... 270 3. Selection of Sampling Sites in the Network...... 272 4. Sample Collection ...... 275 5. Identification ...... 279 6. Preservation...... 279 7. Packing and Transportation...... 280 8. Reporting the Findings...... 280

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Annex 6 Training Program...... 283

Annex 7 Information Flow...... 287

1. Introduction...... 289 2. Reporting the Findings...... 289 3. Planning ...... 290 4. Information Flow ...... 290 5. Notification and Follow-Up ...... 292

Annex 8 Places to be Evaluated...... 297

Annex 9 Determination of Number of Samples ...... 305

1. Scope ...... 307 2. Work Plan ...... 307 3. Number and Frequency of Samples ...... 307 4. Timeframe for Surveillance of Water Systems (203 Systems Constructed by DIGESA-COSUDE) ...... 308 5. Budget ...... 308

Annex 10 Sanitary Inspection Report Form ...... 317

Annex 11 Quality Assurance of Data ...... 321

1. Introduction...... 323 2. Number of Evaluations Conducted (1) ...... 323 3. Consistency of Results (2) ...... 323 4. Number of Direct Supervisions (3)...... 324 5. Number of Verifications Conducted in the Field (4) ...... 324 6. Quality of Field Work (5) ...... 324

List of Tables

Annex 2

Table 1 Implementation and Complementation of Laboratories...... 237

Annex 3

Table 1 Bacteriological Parameters ...... 241 Table 2 Parameters that Affect Health...... 242 Table 3 Parameters that Affect Acceptability of the Water...... 242 Table 4 Sampling Frequency (Treatment Plant, Groundwater Sources and Services Reservoirs) ...... 243 Table 5 Sampling Frequency (Distribution Network) ...... 243 Table 6 Frequency of Evaluation...... 244

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Annex 4

Form M-1 Community Registration Form...... 248 Form M-2 Form to Assess Management and Coverage...... 249 Form M-3 Form to Assess the Sanitary Condition of the Water Supply Infrastructure...... 250 Form M-4 Form for Collecting Water Samples and Assessing the Quality of the Service ..... 253 Form M-5 Form to Verify Habits of Hygiene and Presence of Diseases in the Communities 254 Form M-6 Form to Verify Habits of Hygiene in the School Population ...... 256

Annex 5

Table 1 Containers and Type of Preservatives by Group of Determinations...... 279 Form L-1 Report on Analysis of Water Samples...... 281 Form L-2 Report on Physico-Chemical Analysis of Water Sample ...... 282

Annex 7

Form N-1 Letter – Re. Surveillance of the Quality of Drinking Water...... 293 Form N-2 Letter – Re. Surveillance of the Quality of Drinking Water...... 294 Form S-1 Summary of Activities Carried Out during the Quarter ...... 295 Form S-2 Summary of Activities Carried Out during the Quarter ...... 296

Annex 8

Table 1 Water Supply System. SANBASUR Project...... 299

Annex 9

Table 1 Analyses Required in Three Years Planned for Control and Surveillance of Drinking Water Quality...... 308 Table 2 Chronogram of Activities ...... 308 Table 3 Cost of Analyses...... 309 Table 4 Sampling Plan for the Surveillance of the Water Quality, and Water Supply Administration and Systems...... 311 Table 5 Summary of the Water Supply Systems. SANSABUR Project Ground and Surface Water ...... 312 Table 6 Number of Samples for Physico-Chemical Analysis, Groundwater – 2001 ...... 313 Table 7 Number of Samples for Physico-Chemical Analysis, Surface Water – 2001...... 313 Table 8 Number of Samples for Chlorine Residual Analysis, Groundwater – 2001...... 314 Table 9 Number of Samples for Chlorine Residual Analysis, Surface Water – 2001...... 315 Table 10 Projections ...... 315

Annex 11

Form Quality Assurance of Data...... 326

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List of Figures

Annex 5

Figure 1 Criteria for Decision on Testing for Coliforms ...... 270 Figure 2 Sample Bottle ...... 271 Figure 3 Sampling Sites in Open Distribution Systems...... 273 Figure 4 Sampling Sites in Closed Distribution Systems ...... 274 Figure 5 Sampling in Mixed Distribution Systems...... 274

Annex 7

Figure 1 Information Flow Surveillance of the Quality of the Water Supply Services ...... 291

Annex 9

Figure 1 Program for the Surveillance of Drinking Water Quality, SANSABUR Project ... 310

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FOREWORD

The guidelines for the surveillance and control of drinking water quality are the outcome of a cooperation agreement between the Pan American Health Organization/World Health Organization (PAHO/WHO) and the United States Environmental Protection Agency (USEPA) as part of our commitment to take action on the Plan for the Improvement of Water Quality in Latin America and the Caribbean.

The institution responsible for the operational development of this activity was the Pan American Center for Sanitary Engineering and Earthquake Sciences (PAHO/CEPIS), and the general coordinator and officer in charge of the project was Felipe Solsona, advisor in water quality. His counterpart in USEPA was Fred Hauchmann.

In producing this document, we followed a process which began with two workshops, where international experts on Drinking Water Quality came together to outline its contents and scope. Annex 1 gives details of the workshops and lists the participating experts.

Based on the guidelines produced at the two workshops, Ricardo Rojas, PAHO/CEPIS consultant and expert in water quality, drafted the document. Once completed, it was distributed to a number of international reviewers for assessment. Their names, countries of residence, and the agencies to which they belong are also listed in Annex 1. The resulting criticisms were duly analyzed and reviewers' suggestions have been incorporated into this final version.

At the same time, three case studies were prepared and developed as didactic complements to the Guidelines. The case studies are presented as appendices.

The first case study, a nationwide study, makes use of the data contributed by several countries in a spirit of cooperation. These data were consolidated to describe a single imaginary nation, referred to as "The Country".

The second case study, of an urban area, describes the supply system of the city of Cuzco (Peru). The city's water supply company supported us in this work.

Finally, for the third study, on water systems in a rural environment, we worked with the rural municipalities of the region of Cuzco, with the support of SANBASUR, a Peruvian agency sponsored by Swiss International Cooperation.

PAHO/WHO and USEPA express their gratitude to all those individuals and institutions whose contributions have made this document possible.

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Conceptual Framework 1

1. Conceptual Framework

1.1 Introduction

This publication, Guidelines for the Surveillance and Control of Drinking Water Quality, explains how to plan programs for the surveillance and control of water quality. It defines the criteria to be used when determining the level of intervention, indicates the desired scope of legislation, regulation, policy and basic management, and identifies the main support tasks that will be needed for an effective planning of future surveillance and control work.

The plans proposed in these Guidelines are based on successful experiences and recent scientific information. The procedures recommended here take into account an ample range of implementation levels, from basic to advanced. The procedures described, which can serve as a reference for drawing up standards and directives and for designing programs or other types of conditions, should be applied with care, bearing the following factors in mind: the sanitary vulnerability of the community; the availability of human, material and economic resources; the institutional status (public or private) of the water-supplying companies or institutions, and their capacity; the institutional status and capacity of the body responsible for surveillance at the national and local levels; and sanitary legislation currently in force. These Guidelines place emphasis on some elementary surveillance and control procedures which are indispensable if we are to guarantee safe water for human consumption.

During the implementation stage of a water surveillance and control program, a uniform level of intervention for the whole country, region or department does not necessarily need to be established. The health authorities or regulatory institution will be able to define the most appropriate local level of surveillance and control, bearing in mind the capacity of the laboratories both of the surveillance institution and of the supplier. The criterion must be not to waste the funds available by demanding high levels of surveillance and control, when the institutions responsible for this work are not able to provide such levels. Usually, when requirements exceed the capacity of these institutions, programs simply do not get implemented.

Countries drawing up directives or standards for water surveillance and control programs should make a careful evaluation of the costs and benefits involved, in order to set priorities reflecting possible impacts on human health.

Finally, in developing countries where communicable diseases are a public health problem, surveillance should focus on determining improvements in the bacteriological quality of the drinking water, minimizing risk factors which lead to the deterioration of water quality in the distribution system, and improving or modernizing practices in the operation, maintenance, design and construction of water supply systems.

2 Guidelines for the Surveillance and Control of Drinking Water Quality

1.1.1 General

The main aim of the Guidelines for the Surveillance and Control of Drinking Water Quality is to define the strategies that will make it possible to detect, foresee, and prevent the pollution of drinking water, in order to minimize the incidence of waterborne diseases. This guide, along with the Guidelines for Drinking Water Quality published by the World Health Organization (WHO), is addressed to persons who work in the protection of public health and in the preparation of national, regional or local directives, standards, plans or programs on the subject, as well as to individuals and institutions linked with, or committed to, the water supply service.

Since water is indispensable for life, consumers must have a satisfactory water supply, so the supplier must make every effort to provide water of the best quality under any given circumstances. In this context, the first line of defense is the evaluation of the physical, chemical and microbiological quality of the water. Such an evaluation is made by performing analyses and carrying out surveillance and control of the treatment processes.

The surveillance and control of the microbiological quality of water for human consumption should be routine activities. It must be realized that these activities are of the utmost importance. It has been recognized that the greatest risk of falling prey to diseases caused by pathogenic microorganisms lies in the consumption of water polluted by human or animal feces. However, risks of this kind cannot be completely removed because such diseases can also be spread by personal contact, sprays and food. The importance of water quality surveillance and control is that the safety of the water supplied is the factor that will reduce the possibility of diseases being spread as mentioned above, as it facilitates personal habits of hygiene and hygiene in the home.

The health risk represented by chemical substances in the water differs from that posed by microbiological pollutants, in that the effects of the latter are usually more acute. There are few chemicals which, in concentrations that can normally be detected in polluted water, cause health problems with immediate effects; rather, deterioration in health caused by chemicals in the water will usually become apparent only after long periods of exposure. The chemicals which take on special significance are therefore represented by cumulative contaminants. This is why the surveillance and control of chemical contaminants are considered to be of secondary importance when the water is polluted by microorganisms.

The use of chemical disinfectants plays a very important role in the conservation of the microbiological quality of water. It is true that these disinfectants can form chemical by-products hazardous to health, but the risk is extremely small in comparison with the risks posed by inadequate or deficient disinfecting of the water.

Another factor of great relevance is the evaluation of the organoleptic characteristics of the water, that is, those which can be detected by the consumers' senses, such as turbidity, color, odor, and taste. This is an essential aspect because deficiencies in these characteristics can cause

Conceptual Framework 3

customers to reject the supplied water and start using an alternative, uncontrolled water source. However, it is also recognized that the absence of unpleasant sensory effects does not necessarily guarantee that the water is safe for human consumption.

On the other hand, sanitary inspection makes it possible to detect conditions or situations that increase the risk of water pollution, but which cannot always be determined by routine analyses unless the contamination is occurring at the same time that the sample is being taken. Sanitary inspection is a sensory evaluation of the physical conditions of the water production, storage and distribution facilities, principally of the most vulnerable parts and those most closely associated with the conservation of water quality. It enables structural or operational deficiencies to be detected in the supply system. Sanitary inspection consists of: (a) evaluation of physical conditions; (b) evaluation of the level of hygiene and (c) evaluation of operational practices. "Physical conditions" refers to the safety of the different components of the system; the "level of hygiene" refers to order and cleanliness in the facilities and their surroundings; and "operational practices" refers to the operational procedures of production and distribution of the water supply system.

1.1.2 Nature of the Guidelines

It should be emphasized that these Guidelines contain recommendations to facilitate the drawing-up of surveillance and control plans, and to help identify the programs that will need to be put in place at a given level of intervention to conserve or protect drinking water quality. In conjunction with these Guidelines, the following concepts must be applied:

a) The suggested levels of action represent different degrees of intervention aimed at minimizing the risk to health posed by the consumption of polluted water.

b) National standards, directives and programs should take into account the sanitary, geographic and socioeconomic situation and any condition which could put the quality of drinking water at risk.

c) The plan to be formulated must be practical and appropriate to the country's situation, and it must protect the public health of the population served by the communal or private water supply system.

d) If non-compliance with water quality standards is detected, this does not necessarily mean that the water is not totally fit for human consumption, but it can indicate deficiencies in the system's infrastructure or operations, which increase the risk to consumers’ health.

e) The proportion of samples that fail to comply with quality standards, and the period during which this situation lasts, serve to evaluate the risk to water consumers’ health.

4 Guidelines for the Surveillance and Control of Drinking Water Quality

1.1.3 Importance of the Quality of Drinking Water

Water for human consumption has been defined in the World Health Organization (WHO) Guidelines for Drinking Water Quality as that water which is “adequate for human consumption and for all normal domestic use, including personal hygiene.” Implicit in this definition is the principle that the use of this water should not present any risk of disease to consumers.

Recognition of water as a vehicle for the transmission of diseases dates from long ago. Diseases prevalent in developing countries, where the water supply and sanitation are deficient, are caused by bacteria, viruses, protozoa and helminths. Such organisms cause diseases which range from minor gastroenteritis to serious and fatal epidemic diseases.

Nevertheless, water quality alone is not enough to ensure the benefits of human health. Three additional requisites must be met: quantity, continuity and reasonable cost. Quite apart from the responsibilities of the supplier, the consumers themselves must be knowledgeable about the appropriate use of water, adequate nutrition, and food hygiene, as well as the proper disposal of excreta. Messages aimed at improving habits and customs related to good water use should therefore be conveyed through educational programs complementary to the activities of the supplier, designed to prevent the public from having the false impression that water quality by itself prevents diseases.

Water that is fit for human consumption when it enters the distribution system can deteriorate before reaching the consumer. Once in the distribution system, water can become contaminated for different reasons: crossed connections; backsiphonage; broken pipes; fire hydrants, home connections, defective tanks and reservoirs; and during the laying of new pipes or repair work carried out with few security measures. Another recontamination factor, of great importance in cities or localities where there is a shortage of water, is the interruption of the supply as a result of rotation of service from one supply area to another in an attempt to cover the demand for water.

Thus, in systems where the water supply is limited, the deterioration of its physical, chemical and, above all, microbiological quality by the time it reaches the customer's home is frequently a consequence of inadequate manipulation and storage.

1.1.4 Health Impact of Pathogenic Agents in the Water

The provision of good quality water was one of the eight components of primary health care identified at the International Conference on Primary Health Care held in Alma-Ata in 1978.

In most countries the main risks associated with the consumption of polluted water refer to microorganisms. As indicated in Chapter 18 of “Agenda 21” of the United Nations Conference on the Environment and Development, “approximately 80% of all diseases and more than a third of the deaths in developing countries are caused by the consumption of

Conceptual Framework 5

contaminated water, and on average up to a tenth of the productive lifetime of each person is taken up by water-related diseases.”

The risk of catching water-borne diseases is proportional to the degree to which pathogenic microorganisms are present in the water. However, this relationship is not necessarily a simple one, since risk also depends on other factors such as the amount consumed and the susceptibility of the host. Water for human consumption is only one vehicle for the transmission of diseases. Because of the multiplicity of means of transmission, not only improvement in quality and availability of water, but also the sanitary disposal of excreta and the application of adequate rules of hygiene, are important factors in the reduction of morbidity and mortality caused by diarrhoeal diseases.

Independently of the agents which affect drinking water quality, we must be aware of the risks caused by inadequate protection of water sources, bad management of water during the treatment process, and the poor conservation of its quality in the distribution systems and customers' homes. The absence of diseases in communities supplied with water of bad or doubtful quality does not mean that the population is not subject to the risk of an epidemic.

The list of water-borne agents which constitute a problem worldwide and which can produce adverse effects on health includes microorganisms, chemicals and radionuclides. Among the microbiological agents are bacteria, such as the Vibrio cholerae, Salmonella and Shigella; viruses such as hepatitis A and E; and protozoa such as Giardia and Cryptosporidium. Among the chemical agents are inorganic components such as nitrates, fluorine, arsenic; heavy metals such as lead, cadmium, mercury; and organic components such as substances for industrial use, toxic chemicals used in agriculture, and disinfection byproducts.

Outstanding among the many cases of transmission of diseases related to the microbiological quality of drinking water are outbreaks of Criptosporidium associated with defects in the treatment process, and entero-hemorrhagic E. coli associated with the replacement of water meters and ruptures in the distribution pipes, among others.

In Latin America, in 1991, the spread of cholera was attributed to inadequate water and sanitation supplies, and to the lack of environmental control measures.

1.1.5 Benefits of the Surveillance and Control of Water Quality

The good quality of drinking water assures the consumer of protection against the presence of pathogenic agents and physical and chemical compounds harmful to his or her health. The information provided by drinking water surveillance and control programs, in addition to the obvious benefit of reducing water-borne diseases, provides a means of improving the quality of the water supply service.

Improvement in the quality of the water supply service is achieved by: a) identifying the need to extend the basic sanitation infrastructure, b) rehabilitating the water supply system, c) training

6 Guidelines for the Surveillance and Control of Drinking Water Quality

staff in charge of the operation, maintenance and administration of the water supply and sewage services, d) identifying measures for preserving water sources, and e) bringing up to date the regulations, standards and codes of good practice relating to the quality of water for human consumption. In addition, the processing of information at the regional or national level will make it possible for the country to plan national investment in extending service coverage, and improving and rehabilitating services in the water and sanitation sectors.

1.2 Background, Present Situation and Trends

Before 1991 the countries of Latin America and the Caribbean focused on quantity rather than quality of water for human consumption. The outbreak of cholera in Peru that year was a severe blow to that trend and showed up the poor sanitary conditions of water supply services, especially with regard to water quality. In consequence, many of the governments of the Region applied for aid through the mechanisms available within the Region.

At the “International Conference on Water Quality,” sponsored by the Pan American Health Organization and held in Lima, Peru in 1996 at the Pan American Center of Sanitary Engineering and Environmental Sciences, PAHO/CEPIS, one of the recommendations was that the countries of the Region develop programs for the surveillance and control of drinking water quality.

A similar request was made to the PAHO by the American heads of state at the Summit Meeting of Santa Cruz de la Sierra in 1996, and to address these needs the Organization drew up a Regional Plan for Improving the Drinking Water Quality, which contained a diagnosis and a specific proposal of action. The diagnosis clearly recognizes that the situation is not the best with respect to the monitoring and control of drinking water quality.

Although the coverage of drinking water services has increased in absolute terms, nevertheless with respect to quantity and quality, in relative terms, the values have fallen. Almost at the end of the twentieth century PAHO figures showed that only 41% of the population were consuming treated and disinfected water which could be considered “safe.”

A historic report shows that countries which in the 1950s and 1960s had active surveillance and control programs discontinued them in the 1970s and 1980s. Although the alarm caused by the reappearance of cholera triggered some important initiatives, there can be no question that in many cases the initiative failed for lack of political support. Moreover, there was an evident lack of good, up-to-date instruments to design programs coherent with the circumstances facing the governments and institutions of the countries concerned.

Within that context, and bearing in mind the appearance of a more executive tendency in these countries, as well as the presence of top and intermediate level officials and technical staff who recognize the need for specific action and the lack of instruments appropriate to the real situation of the countries, the need for drawing up an appropriate framework to support this favorable trend was identified.

Conceptual Framework 7

The Regional Plan, together with other regional and local initiatives, is a contribution toward satisfying the need for a framework document. It is our hope that the present Guidelines will be a useful addition to that effort, since they present a methodology that can be applied by governments, agencies, public and private companies and customers in general, to help improve the quality of water supply services.

1.3 General Concepts, Principles and Objectives

1.3.1 Sanitary Surveillance of Drinking Water Quality

Sanitary surveillance can be defined as “the combined measures adopted by the competent authorities to evaluate the risk to public health of the quality of water provided by public and private water systems, as well as to evaluate the degree of compliance with legislation linked with water quality.”

In theory, sanitary surveillance has two major components: (a) correlation of the physical, chemical and microbiological quality of the water with the incidence of waterborne diseases transmitted, in order to determine the health impact; and (b) permanent and systematic review of the information on water quality to confirm that the source, treatment and distribution conform to established objectives and rules. Thus, the permanent examination of the supply system, by means of sanitary inspection and evaluation of drinking water quality, as well as the analysis of the community's epidemiological profile, serve the institution responsible for sanitary surveillance as risk evaluation instruments.

From the above it can be deduced that sanitary surveillance is an activity of investigation generally carried out by the competent public health authorities, directed toward identifying and evaluating risk factors associated with public water systems and which can imply a threat to the health of the population. It is an activity which is preventive as well as corrective in ensuring the reliability and safety of water for human consumption. Surveillance is preventive because it facilitates the early detection of risk factors so that action can be taken before abnormalities in water quality occur or negative health impacts are produced. It is corrective because it permits the identification of sources of outbreaks of water-related diseases in order to act on them, re- establish water quality and keep the problem from spreading. If good use is made of the information resulting from this type of analysis or evaluation, it will be possible to improve standards on drinking water quality, as well as operational, maintenance, distribution and storage procedures and the regulations concerning design, construction, building materials or chemicals employed in water treatment.

Sanitary surveillance can be applied just as well to public and private water supply systems as to water collected from individual sources or by other means. Therefore, the responsibility of the institution in charge of sanitary surveillance is to supervise all supply systems and sources of water potentially usable for human consumption.

8 Guidelines for the Surveillance and Control of Drinking Water Quality

1.3.2 Control of Drinking Water Quality

Control of water quality can be defined as “the combined activities carried out on a continual basis by the supplier to verify that the quality of the water supplied to the population conforms to legislation.”

This definition of quality control implies that the water supplier is responsible for the quality of the water that it produces and distributes, and for the security of the system which it operates. The supplier can comply with these obligations by means of a combination of preventive maintenance and good operational practices, supported by the ongoing evaluation of the quality of the sources, of the treatment processes and of the distribution system, together with sanitary inspections. These measures together ensure the good quality of the water and the absence of recontamination in the distribution system.

A supply area is normally assigned to the public or private supplier. The supplier's responsibility in terms of quality of the product delivered (water of the quality stipulated in legal standards) covers the water from the time it leaves the treatment plant or supply wells until it enters the customer’s home. The quality of water in the home is the responsibility of its inhabitants.

On the other hand, the quality of water distributed by tank trucks or other means which do not imply the participation of public or private suppliers, and which are common in periurban areas, is not usually the responsibility of the water supplier. In such cases the quality control activities are generally assumed by a public or private institution.

In periurban and rural areas where the water supply services are administered by the community itself, these services must, as in the previous case, be controlled by a public or private institution. Usually, the Ministry of Health entrusts this task to the institution responsible for sanitary surveillance. However, it is recommended that a unit independent from the sanitary surveillance department carry out the control work, even though both may belong to the same Ministry and use the same central laboratory. The use of the same laboratory is recommended in order not to duplicate the investment in analytical infrastructure.

1.3.3 Relationship between Sanitary Surveillance and Control of Water Quality

The little difference between the concepts of sanitary surveillance and quality control leads to the fact that there is not a clear division of responsibilities between the unit responsible for sanitary surveillance and the one responsible for water supply, since the mission of both is to assure adequate quality of drinking water. The WHO has differentiated between the two activities in the following way:

In general, it is the responsibility of the authorities in charge of local water supply to guarantee that the water provided be of the quality stipulated in the standards. Nevertheless, an independent body (national, state, provincial or

Conceptual Framework 9

local) can better perform the work of sanitary surveillance (that is to evaluate the risk to public health of the quality of water provided by the supplier and to determine its degree of compliance with the legislation related to preservation and conservation of water for human consumption). While it is true that both functions complement each other, experience has shown that they are performed better when carried out by institutions independent of each other, because of conflicts of priorities which emerge when the two functions are combined.

Quality control differs from surveillance in institutional responsibility, in the type of activity involved, in the geographical areas of intervention, the frequency of sampling, and the interpretation and application of the results, but they share common traits in planning and implementation.

In countries where regulatory entities exist, these can facilitate surveillance through directives which oblige suppliers to implement quality control programs for drinking water and periodically to report the results of their evaluation of the water supply systems. In such cases, surveillance can be called operational surveillance.

While the supplier is responsible for routine control of water quality, for monitoring to ensure good operational practices, and for taking measures to improve the quality of the supply, either the body responsible for sanitary surveillance or the regulating entity is responsible for periodically carrying out an audit of safety aspects, summarizing the data provided by the supplier, and promoting improvements in the quality of the water supply service.

Wherever the water supplier has set up an effective program for quality control, and either the regulating entity verifies its compliance or the supplier is efficiently audited by an external institution, the body in charge of sanitary surveillance can place more emphasis on populations who have been receiving less attention, urban as well as rural and periurban. In this way the supplier and the regulating entity become fundamental parts of sanitary surveillance; it is important, therefore, that both be conscious of the role they play in the surveillance process.

In summary, the supplier evaluates the quality of the water provided to determine its degree of compliance with the quality standard and reports the results to the regulatory entity or to the sanitary surveillance body, which validates or verifies by sampling the quality of the water in the distribution network and audits the supplier in everything related to the operational and administrative processes associated with the quality control program.

However, external auditors are selected (by the sanitary surveillance body) to perform the analytical quality control in the laboratories of the regulatory entity and of the supplier. The external auditor reports to the sanitary surveillance body about the work and the reliability of the analytical processes. This information in then passed on to the regulatory entity and to the supplier so that the latter can take corrective measures, if necessary.

10 Guidelines for the Surveillance and Control of Drinking Water Quality

For its part, the epidemiology office of the Ministry of Health reports to the sanitary surveillance body on the incidence and prevalence of diseases related to water quality, information which is then correlated with data provided by the supplier to investigate the probable origins of the diseases. If a consistent correlation is obtained, improvements in the water quality standard or regulations or procedures linked to the preservation and conservation of water in the distribution system can be introduced. Figure 1. summarizes the relationship between surveillance and control, emphasizing the main responsibilities of each.

1.4 Legal Framework

The effectiveness of sanitary surveillance programs, operational surveillance and quality control of drinking water depends on legislation which responds to national, jurisdictional and constitutional situations, among others. The legal framework covers three interconnected areas: political, legislative and regulatory.

Political intervention is fundamental for facilitating the revision, modification, preparation and adoption of laws and regulations which enable programs to be developed for the surveillance and control of drinking water quality. Legislative intervention provides a legal framework which must be of the highest level. The legal framework is made up of the pertinent laws, decrees and resolutions.

Conceptually, legislation should identify the institution responsible for surveillance and confer on it the authority to verify that regulations and standards relating to the conservation and preservation of the quality of drinking water are adhered to. It places special emphasis on assessing the safety of the water and of the sanitary infrastructure by studying the results of analyses, sanitary inspections and specific audits; as well as verification of the reliability of the information provided by the supplier. This surveillance body must also be given the authority to oblige the supplier to take the necessary corrective measures in cases of emergency, especially when microbial contamination has been detected.

The legislation must also define the responsibility of the surveillance body and that of the control unit regarding evaluation and follow-up of water quality at the sources of supply, in the production process, and in the distribution network; it must specify sanctions for single or continuous violations of regulations; and define who is responsible for establishing the quality standard for drinking water. In addition, the legislation must take into account the fact that sanitary and operational surveillance are first and foremost a function of support and advice, and only in the second place a function of punishment for failure to comply with standards and regulations.

With regard to the supplier, its authority, functions, and legal rights and obligations must be specified, with emphasis on the fact that it is legally obliged to provide water that meets the established standards, and to supervise, inspect, operate and maintain the water supply system. Moreover, the supplier must be considered capable of bringing lawsuits against third parties to protect its water sources and its distribution system from any source of foreign contamination.

Samples Control External Laboratory (Supplier ) Audit Results

g n li p m a S s Information e r

u t s n a e

e m t m n i Quality e o A v p u ti d p Standard i c t e A r r o C U pd ati Distribution ng System V alid atio n ( sam pli ng )

Epidemiological Certified or Surveillance Accredited Evaluation Water-borne diseases Laboratory

Figure 1. Relationship between Control and Surveillance of Drinking Water Quality

12 Guidelines for the Surveillance and Control of Drinking Water Quality

With reference to the regulatory area, the actions of the pertinent authorities and institutions involved in the surveillance and control of water quality must be backed up by regulations, standards or codes of practice which stipulate the quality of water to be supplied, acceptable treatment processes, appropriate treatment and distribution practices, design and construction criteria, types of building materials, the quality of chemical products to be used in water treatment, and the type of care required in water distribution, among other specifications.

The regulations, standards or codes of practice must be based on a health risk/health benefit ratio to ensure that the procedures adopted are consonant with the situation of the country. These procedures will therefore take national priorities into account, as well as sanitary, economic, human and institutional factors.

The power to promulgate and modify water quality standards, codes of practice and other technical regulations relating to the protection of human health should be invested in the competent sector, usually represented by the Ministry of Health.

Where regulatory entities exist, they will be able to issue directives which may eventually require of the suppliers a quality superior to that specified in the standard, but never lower. Regulatory entities will not be able to issue directives that in any way contradict the regulations, standards or codes issued by the competent authorities.

In conclusion, in order for the surveillance program to be effective, the regulatory entity and the surveillance body need the pertinent laws to be in place, as well as the mechanisms to monitor compliance with those laws. It is also important for the surveillance body to establish a positive, supportive relationship with the supplier. Without detriment to the above, the existence of legislation that is out-of-date or in process of being updated should not be a taken as a reason to postpone or prevent the execution of programs for the surveillance and control of drinking water quality.

1.5 Political and Institutional Framework, and Responsibilities

In many countries the institution responsible for surveillance is the Ministry of Health and its regional or local offices. In other countries it is the environmental protection agency or the departments of environmental health of local governments. Preferably, the surveillance body should be a national institution designated by law and operative at a central and decentralized level, so that it will be able to provide efficient service at the local or district level. The institution made responsible for sanitary surveillance should have the sole responsibility for this surveillance, whose purpose is to protect people from water-borne diseases and from other hazards associated with water supply systems.

Surveillance bodies are under the obligation to evaluate water quality data obtained from the supplier in compliance with its quality control program, as well as to validate, through selective sampling, the supplier’s own sampling program.

Conceptual Framework 13

Additionally, the sanitary surveillance body must qualify and select the independent auditors who will be in charge of auditing the suppliers’ laboratories in order to guarantee the quality of results of analyses.

These activities should be complemented by a follow-up of the supplier's compliance with any corrective measures prescribed, and its compliance with submitting regular reports on the state of water quality at the regional and national level. These reports will serve as a planning tool for investments to improve water quality in particular and the water supply service in general.

One important responsibility of the sanitary surveillance body is that of working in coordination with the suppliers and the epidemiology office of the Ministry of Health, and of correlating the information obtained from both sources, in order to identify and evaluate the risk factors connected with water quality and the supply service which can represent danger to consumers’ health.

In those cases where the responsible institution has the mandate – in addition to sanitary surveillance – to effect water quality control in places not served by public or private suppliers, it is essential that there be two executive units working independently. This will reduce to a minimum the likelihood of disputes that would arise if both activities were carried out by a single institution. In this way, problems detected by the control unit or observations made by the sanitary surveillance unit can be tackled independently by each of the parties involved, maintaining a relationship between the two which is similar to that described between the supplier and the sanitary or operational surveillance body.

Water quality control is carried out by the supplier. Within the supplier's organization, the quality control department is responsible for planning, sampling, inspection, recording, identification of support measures, and follow-up of corrective measures. This department must work with, and coordinate with, the highest levels of the organization, especially its management, and act as a support unit in decision-making processes.

Diagnoses made by the water quality control area, and corrective measures it designs will be based on results obtained by the quality control program in its two basic aspects: analytical (results of laboratory analyses) and sanitary inspections.

It is of the utmost importance that the water quality control department in the supplier's organization work independently from the water production and distribution areas, and independently from the laboratory. However, there must be constant coordination between them to deal with aspects of the safety and effectiveness of the different processes of obtaining, maintaining and re-establishing – when necessary – water quality. The water production and distribution areas must not take any steps to re-establish the treatment process or supply service in an affected area without first obtaining the approval of the quality control department.

14 Guidelines for the Surveillance and Control of Drinking Water Quality

By the same token, the commercial, engineering, hydrology, treatment plant, human resources development and public relations areas, among others, must maintain a close coordination with the water quality control department with respect to their responsibilities

Finally, it is important that the organizational structure of the areas responsible for quality control in the water company, and for sanitary surveillance in the surveillance body, be conducive to ensuring compliance with the legislation, standards or codes of practice on drinking water quality. Their organizational structures should also be such as to enable the two units to undertake complementary tasks.

1.6 Goals and Priorities

When identifying goals, we must bear in mind that sanitary surveillance does not only contribute to the protection of public health and promote improvement in water quality: it also influences the quantity, coverage, cost and continuity of the water supply. For that reason, a systematic data analysis program needs to be set up, to analyze the data obtained by the supplier and those produced by the responsible surveillance unit.

The effectiveness of the surveillance work depends on good planning and specific objectives. The objectives will vary according to the country's national and regional conditions and priorities. They include: a) monitoring quality trends in the water supply service; b) identifying the main deficiencies of the water supply services; c) verifying the operational efficiency of the treatment plants; d) making information available at the pertinent levels for planning future investments in rehabilitation, improvement or expansion of the water supply service; e) detecting sources of contamination; f) improving standards, regulations or codes of practice aimed at enhancing the quality of the services; g) providing sanitary education for users of water supply services, etc.

Goals serve as a link between complementary or specific objectives and the work plan, and should be reviewed periodically to make sure they are consonant with the current situation. When setting up a surveillance program, the goals are usually: a) to make an inventory of the water supply systems; b) to establish methods for water analysis, sampling, data collection, etc.; c) to install regional laboratories for the verification of results from the sampling program; d) to provide training in surveillance; e) to establish the scope of surveillance; f) to define how information will be processed and the kinds of reports to be written, etc.

With respect to the analytical determinations that should be included in the planning of surveillance programs, it must be stressed that the microbiological quality of drinking water is of prime importance, and top priority must be given to monitoring a bacterial indicator such as total coliforms and thermotolerant coliforms. Chemical pollution is also important, but frequently fades to irrelevance in areas where microbial and parasitic diseases are rife, so it is of lower short-term priority.

Conceptual Framework 15

Some of the concepts mentioned for surveillance in general can be applied when planning and defining the goals for water quality control programs, but generally speaking the supplier places greater emphasis on improving water quality and the supply service than on sanitary education.

Finally, the supplier must be responsible for carrying out a continuous and effective water supply program, including sanitary inspection, supervision, preventive maintenance, continual testing of water quality and preventive and corrective measures aimed at guaranteeing the quality of the water supplied, and in some special cases, the conservation of water quality inside the home.

1.7 Regulatory Entities

The objective of regulatory entities is to guarantee that the water service is provided under the best possible conditions of quality, thereby contributing to the preservation of the health of the population by improving the quality of the water supply.

The regulatory entities are institutions with functional autonomy, and they usually have the following characteristics:

• They issue directives or standards requiring water suppliers to comply with the regulations promulgated by the sanitary authorities. In no case should these directives contradict stipulations made by the sanitary authorities, but they could be even more stringent than the latter in order to achieve a better quality of service. • They supervise the services of water supply, and sewage and drainage systems. • They assess the performance of water suppliers at the national, regional and local level, and promote their development. • They apply sanctions to suppliers which fail to comply with the regulations. • They validate, process and assess the information provided by the water suppliers. This enables them to have reliable information available on the quality of water produced, supplied and consumed, as well as the quality of the service provided to the community.

The scope and responsibilities of the regulatory entities mean that they are ideal entities for supporting the program of sanitary surveillance of public water systems, since they facilitate the work of the surveillance body from a functional and economic point of view.

The sanitary surveillance body can thus be backed up by the regulatory entities in its supervision of the suppliers' performance. By crossing the information supplied by the regulatory entity with the epidemiological reports, the surveillance body can identify any deficiencies which might have allowed pathogenic agents and physical and chemical contaminants to be transmitted in the water provided to consumers by the supplier. It can also identify in this way the improvement of standards for drinking water quality and for regulations or procedures to be employed in the design, construction and management of the water supply system, and standards referring to the chemical products used in water treatment. The regulatory entity thus plays a "watchdog" role from the operational point of view, and the information obtained in this way often proves crucial for carrying out sanitary surveillance.

16 Guidelines for the Surveillance and Control of Drinking Water Quality

1.8 Citizen Participation

In the framework of sanitary surveillance of water quality, participation by the users of the supply system is indispensable. As customers, they have the right to take part in making decisions about their own future, and it is to be hoped that they will be the first to identify the problems. As a result, it is the customers who will be able to warn the supplier and demand the timely adoption of corrective measures.

In addition, if the surveillance personnel establish a close link with the customers, a climate of trust is created, which in turn generates interest and enthusiasm, leading to the implementation of other activities, principally educational, for the adoption of good habits of personal and home hygiene, when necessary.

In small and medium rural and periurban areas, community participation in surveillance activities can take place in a variety of ways. The community can:

• Cooperate in data collection. • Help surveillance staff to collect water samples. • Control quantity and quality of drinking water. • Periodically report results to the sanitary surveillance body. • See that the water supply is put to proper use. • Set priorities in the implementation of corrective measures. • Take on the maintenance of the water supply system and simple repair work. • Request qualified staff to deal with problems which require special attention.

In order for the participation of the community's water management committee to be truly useful, it will be important to implement a simple and effective method for the identification of consumer health risks associated with the water supply, complementing it with training in the application of surveys on basic sanitation and in the identification and adoption of corrective measures. Finally, training of members of the water management committee and community health promoters should be considered, with a view to guaranteeing the sustainability of the water supply system and improved habits on the part of the service users, mainly with regard to water management and conservation.

2. Elements of Surveillance and Control

The WHO has defined three basic elements which every surveillance program must contain and which are perfectly applicable to the quality control of water effected by the supplier. In addition to these basic elements, there are others that can be regarded as support activities and that contribute to the execution of surveillance and control programs.

The basic elements are: a) Evaluation of the physical, chemical and microbiological quality b) Sanitary inspection and operational inspection c) Institutional evaluation.

Elements of Surveillance and Control 17

In turn, the complementary or support elements are:

a) Regulations and standards b) Human, material and economic-financial resources c) Training d) Sanitary education e) Surveys f) Information flow.

Figure 2 shows the different elements that make up a program of surveillance and control of drinking water quality.

2.1 Basic Aspects

2.1.1 Physical-Chemical and Microbiological Evaluation

Physical-chemical and microbiological evaluation of water permits investigation of water quality and determines its acceptability for human consumption. In some cases it includes everything from sampling to reporting on the information obtained.

The water samples should be taken from representative locations at the supply source, at the outlet from the treatment process and at different points in the distribution system such as: storage reservoirs, distribution reservoirs, system components, primary distribution network, secondary network, and if possible in homes. Sampling in homes facilitates the development of sanitary education programs in the community served by the water supply system.

Physical-chemical and microbiological evaluation of water includes the following factors:

• Supply areas • Selection of sampling places or points • Indicators and parameters • Determinations • Sampling • Frequency of sampling Places or points • Analyses • Quality of the analyses and quality control.

r t Analytical Sanitary Supervision of

o quality inspection operations a

q Quality control Compliance Compliance (supplier) withwith standards standards

Validation of Institutional Periodic Audit information evaluation reporting

Surveillance (legal authority) riskrisk factors factors

EvaluationEvaluation of of

Surveillance Surveillance Correlation of Information

Quality control Periodic Epidemiological (non-institutional) reporting information MINSA ISOLATED SYSTEMS (rural and periurban) Adjustment of Planning future standards and Supervision regulations investments Water Sanitary of quality inspection operations Quality control of isolated systems R e s u l t Support

Figure 2. Components of a Program of Control and Surveillance of Drinking Water Quality

Elements of Surveillance and Control 19

a) Supply areas

The WHO Guidelines (volume 3) indicate that, “in systems with more than one water source, the sampling points must be located bearing in mind the number of inhabitants served by each source.”

In some countries the above concept is extended to make the quality control activities more reliable by dividing the areas served into “water supply areas,” or homogeneous geographical areas in terms of (a) source; (b) components; (c) level of service and (d) quality or composition of the water.

The water supply area is considered to be “each part into which the distribution network is subdivided, considering the presence of homogeneous conditions of water quality and pressure, and/or operation related to the operation of the water treatment plant, wells, galleries, springs, reservoirs, pump chambers, or any other element pertaining to the distribution system, and in which no more than a given number of persons live, according to the supplier’s estimates.”

Some standards consider a population size of no more than 50,000, because this number permits a high degree of reliability in the process of quality control of drinking water. However, other numbers can be considered, but only if they reflect the true situation of water quality within the distribution system.

This zoning process requires detailed knowledge of the way in which the water supply system is operated; it must therefore be carried out in coordination with the respective technical area. The following factors need to be determined for the zoning process: the origin of the waters, the attendant components, the population being served, and the urban characteristics. This information facilitates the location of the sampling points. The frequency of sampling is then determined, as well as the number of samples required to evaluate the quality of the water supplied, at the sources, components, primary network, secondary network, and if the situation warrants it, in the customers' homes. This information can also be used in planning the corresponding sanitary inspections.

b) Selection of sampling points or places

The World Health Organization indicates the criteria to be applied in selecting sampling points. These criteria have been adapted in the present document, keeping in mind the concept of the water supply area. Thus, the sampling points must:

• Be representative of the water supply area. • Be uniformly distributed throughout the water supply area. • Bear a certain proportionality to the number of inhabitants in each supply area. • Be located:

20 Guidelines for the Surveillance and Control of Drinking Water Quality

− At the outlet of the water plant, storage reservoirs, distribution reservoirs and wells. − In the primary distribution network. − In the secondary distribution network. − In customers' homes in exceptional cases or to identify the content of sanitary education programs.

With reference to the characteristics of the sampling point, it has traditionally been considered that to reduce problems inherent in the representativeness of the water sample in the distribution system, the sampling points must be installations specifically designed for that end. However, it is recognized today that the installation of such sampling points, together with their maintenance, is an added economic burden for the supplier.

For this reason, it is now permitted to take water samples at user connections, as long as the taking of representative water samples from the distribution network is allowed, and to that effect these sampling points must be the first faucet inside the home connected directly to the distribution network, free of the influence of any type of storage within the home. In all cases, the selection of sampling points must be coordinated between the supplier and the sanitary and operational surveillance body and formally recognized by the supplier and the surveillance authorities as the only valid sampling points for any judgment regarding the quality of the water supplied.

The sampling points may be fixed or variable. The fixed sampling points are taps or faucets installed at certain points of the primary distribution network and at the outlet from the water treatment plant, wells, reservoirs, pumping stations, etc. In the case of groundwater sources (wells, springs, galleries, etc.), two sampling points must be installed, one to determine the quality of water from the source itself and the other, if such be the case, to evaluate the quality of water supplied to the population.

In the secondary water distribution network the number of sampling points per supply area must be two or three times the number of samples required, and the location of the fixed points and variable points depends on the level of risk. The fixed points are, accordingly, located in the places of greatest risk, and in each sampling campaign two thirds of the samples must be taken from these points, if possible. Areas with a history of frequent leaks, low pressure, high population density, absence of drainage, final sections of pipes, etc. are considered to be areas of greatest risk.

The variable points are located in the areas of least risk in each supply area, and in each campaign no less than a third of the required number of samples may be taken from these points.

In addition, and not necessarily forming part of the drinking water quality control program, the supplier will be at liberty to take water samples in other homes to assess the impact of storage or manipulation of the water at the intradomiciliary level. Under special circumstances the supplier may carry out quality control of the water in the customer's home at the request and expense of the customer.

Elements of Surveillance and Control 21

c) Indicators and parameters

For surveillance of the quality of drinking water the World Health Organization recommends the evaluation of: quality, quantity, coverage and continuity of service. These criteria have subsequently been extended and today cost is also considered. In turn, the quality indicator has been divided into: (a) evaluation of water quality; and (b) sanitary inspection of the water supply system. See Table 1.

In the case of water quality control programs where the coverage, cost, continuity and quantity are known, the evaluation is normally reduced to determining the quality of the service in three aspects: analytical, physical conditions of the infrastructure, and operational conditions of the water distribution system.

d) Determinations

The determinations to be carried out by the water supplier must be in agreement with the water quality standards, with the competent authorities, and with the analytical capacity of the laboratory. Table 2 lists the principal analytical determinations that are recommended in the execution of water quality surveillance and control programs; they are grouped according to their analytical complexity, which can also be taken into account for the duly defined different levels of surveillance or control.

e) Sampling

The physical-chemical and microbiological analyses lack any value if the samples analyzed have not been properly collected, stored and identified. Although the recommendations regarding the handling of the samples depend on the parameters to be analyzed, it is recommended that the least possible amount of time be allowed to elapse between the taking of the sample and its analysis; in some cases it should not exceed six hours, and in special circumstances the analysis should be performed within 24 hours of sampling. In addition, the samples must be dispatched in cool boxes, be kept out of the sun, and be packed leaving enough space for a coolant.

Qualified staff must carry out the sampling. They will be able to ensure that the samples are representative of the water being supplied to the customers and that their composition will not be modified during the sampling and transportation. To this effect, the sampling staff must be trained to comply strictly with the prescribed procedures of sampling, preserving, packing and transportation to the laboratory, as well as to determine the content of free chlorine and pH.

22 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 1. Indicators for the Water Supply Service

Coverage: Percentage of the population supplied by a specific water supply or source.

Quantity: Volume of water used for domestic purposes in a determined time-span (usually expressed in liters per person per day) and known as “water supply.”

Continuity: Proportion of time the water is available to the customer (in a faucet or water pipe), or the proportion of days the water is distributed by other means.

Quality: Fitness of the water for human consumption and for all domestic purposes including personal hygiene. It is verified by: - analyses of the physical, chemical and biological characteristics;* - sanitary inspection of the system to investigate the risk of contamination.

Cost: Value of the water supplied for domestic use (usually expressed as a rate).

* In areas or countries with high mortality due to diseases of fecal-oral transmission, it is more important to carry out analyses of fecal indicators (thermotolerant coliforms).

Table 2. Recommended Analytical Determinations a) Initial level – Chlorine residual (total, combined and free) b) Basic level Turbidity Odor pH value Taste Chlorine residual (total, combined and free) Total coliforms Thermotolerant coliforms c) Intermediate level (volumetric) – In addition to the previous Total hardness Calcium E. coli Alkalinity Magnesium Residual - dissolved / total Chlorides d) Intermediate level (colorimetric) – In addition to the previous Sulphates Color Nitrite Manganese Chromium Nitrate Fluoride Iron e) Advanced level – In addition to the previous Aluminum Mercury Lead Arsenic Barium Copper Cyanide Zinc Sodium Cadmium Selenium Phenols f) Complete level - Other determinations of organic and inorganic substances

Elements of Surveillance and Control 23

f) Frequency of sampling

The objective is to determine the continuity of follow-up on drinking water quality that needs to be carried out. The frequency of sampling in the distribution system should take into account the population of each supply area and its category, i.e. urban, periurban, or rural. Thus, in highly populated supply areas, samples must be taken more frequently than in less populated areas.

The WHO Guidelines are very clear with respect to microbiological quality in the system of distribution, but somewhat vague when dealing with the physical-chemical aspect as well as with regard to the evaluation of the water at the treatment plant outlet, water wells and components of the distribution system, so it is left to the judgment of the supplier to determine the frequencies of sampling, bearing in mind the quality of the source and its variability.

Tables 1 to 6 of Annex 1 can be used as a guide in this matter. The tables give suggested sampling frequencies for each type of analysis and for each type of component of the distribution system. These tables were prepared for supply areas of up to 50,000 inhabitants and for two working conditions: standard and reduced, but they can be adapted for smaller sizes and for different degrees of reliability.

The standard condition refers to the number of samples the supplier normally has to take from the supply areas in order to demonstrate compliance with the values laid down in the water quality standard for each parameter. The reduced condition is adopted by the supplier when, after a certain number of years, usually three, the parameters comply with the values required by the water quality standard. If for any reason the values stated in the standard on drinking water quality are not being complied with, the supplier must proceed to increase the number of samples according to the condition of sampling encountered. Thus, if it is in reduced condition it must be returned to standard, and if it is in standard condition the sampling frequency must be increased by 50 or 100 percent.

For supply areas or service reservoirs that supply or store a combination of groundwater and surface water, the tables for surface water are to be applied.

g) Analyses

Physical-chemical and microbiological analyses must be carried out following standardized procedures so that the results produced by the different laboratories in charge of surveillance and control are compatible and can validly be compared.

National and international agencies have published standardized methods for water analysis. It is often considered that adequate analytical accuracy can be achieved by using a particular analytical method. Experience has shown quite the contrary, since a series of different factors can influence the outcome of the tests, regardless of the analytical method used. Such factors include: the purity of the reagents, the type and the operational conditions of the equipment, the degree of

24 Guidelines for the Surveillance and Control of Drinking Water Quality

modification of the analytical method by the laboratory, the analyst's skill, and the care taken by the analyst. These factors often vary over time, even within one same laboratory.

For that reason, it is recommended that in programs for the surveillance and control of drinking water quality the analyses be carried out using universally accepted procedures in order to guarantee the results of the analyses and make sure they are comparable. Among the most well- known procedures are the methods recommended by the International Organization for Standardization (ISO) or the Standard Method for the Analysis of Water and Sewage published by the AWWA, USPH and WPCF of the United States of America.

h) Quality of the analyses and quality control

Normal methods of water analysis to be adopted by surveillance and control programs must be tried out under local conditions to test their accuracy and precision, because the use of standardized methods does not necessarily guarantee reliable and accurate results.

In the context of analytical work the terms analytical quality control and quality assurance are used. Analytical quality control occurs at two levels, internal and external, and is aimed at checking the level of reliability of a given method of analysis. Normally it is expressed in terms of accuracy. If to this internal quality control is added external quality control performed by a specialized institution other than the laboratory, it is possible to obtain the certification of the analytical procedures of one or more physical, chemical or microbiological parameters. In this case the laboratory is known as a “Certified Laboratory,” but its "certified" status refers only to the authorized determination or determinations.

Analytical quality assurance encompasses all the methods adopted by the laboratory, and guarantees to those receiving the data that the laboratory is producing valid results. Thus, the quality assurance process covers the control of analytical quality, the competence and capability of the staff responsible for carrying out the analyses, the guarantee that the laboratory has established a process of control and calibration of the equipment and analytical instruments, control of the reagents and procedures of analysis, meticulous documentation of the analytical methods, availability of the data retrieval system, proper management of data, etc. A laboratory found to comply with this procedure is commonly known as an “Accredited Laboratory.”

Finally, the laboratory must design and apply a safety policy which includes cleanliness, disinfection, control of dangerous substances, proper waste disposal, etc.

Elements of Surveillance and Control 25

2.1.2 Sanitary and Operational Inspection

a) Sanitary inspection

In most cases, sanitary inspection enables an accurate interpretation to be made of the results of laboratory tests. No laboratory result, however carefully the test has been conducted, can be a substitute for comprehensive knowledge of the physical conditions existing at the source of supply, in the treatment area and throughout the water distribution system. Unlike laboratory results, which reveal the condition of the water at a specific time and alert us to the presence of pollution when it has already occurred, sanitary inspection provides advance identification of risks that can result in water contamination or failures in the operation or maintenance of the water supply system.

Sanitary inspection should be carried out by competent staff members. By making a visual inspection of the physical conditions of the components of the water system, and observing the practices exercised throughout the system, they will detect the presence or possible presence of factors which indicate that the quality of the water for human consumption is liable to deteriorate. Especially designed "sanitary surveys" are applied for this purpose. The sanitary inspection comprises: (a) evaluation of the physical conditions of the system, and (b) evaluation of the conditions of hygiene. The "physical conditions" of the supply system refer to the structural safety and operational safety provided by each of the components that make up the water distribution system, as well as the structural and operational safety of the treatment plant, in the preservation and conservation of water quality.

Following the WHO Guidelines, Table 7 of Annex 1 contains the recommendations regarding the number of sanitary inspections to be performed per year and per component of the water supply system. The lower number of inspections will be applied when at least the three last inspections indicate an absence of sanitary defects.

b) Operational inspection

A water supply of poor quality or the deterioration of the original quality within the distribution system is common in developing countries, and this is frequently due to human error or the inexperience of the staff responsible for managing the treatment plants or production centers such as wells, springs or galleries. They are not the only culprits however: also to blame are bad conditions of the storage elements, regulation devices, and pipes of the drinking water distribution system.

The operational inspection therefore plays a relevant role. It seeks to determine the capacity or skill of those responsible for managing either whole processes or individual operations of the different elements of the water supply system. This operational inspection is an activity aimed at assessing the operational staff and identifying their capacity and competence in terms of job compliance, as a means of minimizing the risks of contamination of the water intended for human consumption. It goes without saying that the operational inspection is linked

26 Guidelines for the Surveillance and Control of Drinking Water Quality

with the training or development of human resources, because it enables us to identify gaps in the knowledge of the staff in general and of top-responsibility specialist staff in particular.

2.1.3 Institutional Evaluation

One of the most significant factors in complying with water quality control tasks is the organizational structure of the supplying company itself. The institutional evaluation analyzes the entrepreneurial context in which the unit in charge of performing quality control of drinking water carries out its work, to identify any condition that may constrain or influence that unit's performance or results.

The institutional evaluation examines, among other aspects, the existing organizational model; the institution's policies on water quality control; the vision of its goals on different time horizons; the vertical and horizontal coordination relationships between the control area and the management, as well as with the other areas of the institution; decision-making mechanisms and levels; etc.

The water quality control area also needs to be evaluated on its organization, responsibilities, financial, material, technological, and human resources, experience, and relationships with other institutions, mainly with the surveillance body, etc.

2.2 Support Aspects

2.2.1 Regulations and Standards

Within a country's body of legal instruments, the standard on the quality of water for human consumption can hardly be said to hold a preponderant position. However, if this standard is not well structured or is not well adapted to the conditions of the country or region in question, the whole legal structure in support of the standard will be of little value in itself, and of even less use in ensuring successful surveillance and quality control programs.

The standard provides a yardstick by which we can evaluate the operational processes, and measure their efficiency and also their cost. An over-demanding standard will imply higher or extra operational expenses for the suppliers, thereby impacting on the water rate, while an over-lenient standard is in itself conducive to sanitary risk which will directly affect the users of the water supply services.

The promulgation of the water quality standard should be the responsibility of a specific institution (usually the Sanitation Authorities). However, it should not be drawn up unilaterally; rather, it should be the product of a multi-institution and multi-sector exercise, where all the parties involved in the water supply service are entitled to express their viewpoints. Regardless of which institution has the authority to issue the standard, a water quality standard must be the result of a negotiated process involving all the stakeholders.

Elements of Surveillance and Control 27

Since 1958, the WHO has periodically (approximately every ten years) published documents that have served as a basis for the drawing up of national standards on the quality of water for human consumption. These documents provide a series of sanitary criteria and a list of parameters with values indicative of the highest concentrations that drinking water is permitted to contain if it is to be qualified as safe for human consumption.

Volume 1 of the current WHO water quality guidelines lists a large number of possible pollutants, in an effort to respond to the needs of the different countries. However, it is unlikely that all the pollutants mentioned in those guidelines will be present in the supply water of any one given country. An attempt to follow the WHO guidelines indiscriminately could therefore lead to a situation in which the water standards adopted by a country do not address its real public health needs, and will in fact become a serious obstacle during the implementation of water quality surveillance and control programs.

It is highly to be recommended that the national drinking water standard be a realistic one; the sanitary risk to be taken must be proportionate to the cost of the prescribed measures. Consequently, those responsible for drawing up the water quality standard must take special care with the selection of parameters, taking into account the health, technological, economic, social, and cultural reality of their country, the types of human activities carried out there, as well as geological features of the country in general and of the regions in particular, and the size of the cities. In addition, in those countries where economic and human resources are limited, short- and medium- term goals should be set for the surveillance and control of water quality, in such a way to ensure that the most serious and most common risks to human health – those normally associated with microbiological contamination – will be the first to be identified and brought under control.

It should be emphasized, moreover, that there is no obligation to include relatively insignificant chemicals in the standard, or those that have little impact on the public health of a country or specific region. Normally, the inclusion of negligible chemicals results in an effort that does not draw any response from the water suppliers or even from the surveillance body itself.

In the identification and selection of the pertinent parameters, we need to evaluate the risks to which the consumers of the water will be exposed in the event that higher values than those suggested in Volume 1 of the WHO Guidelines for Drinking-Water Quality are adopted. The assessment must take into account the clinical, physiological and epidemiological considerations indicated in Volume 2 of the Guidelines (Health Criteria and Support Information) in order to adjust the values or concentrations of the selected parameters to the actual situation of the country, state, region, or province.

A procedure that has been successfully applied is the development of an "indisputable and unappealable" framework standard to be adopted in its entirety by the provinces or states of the country for the drawing up of their own local standards. However, those responsible for preparing this framework standard must bear in mind, as previously mentioned, the real conditions of the individual provinces and their different situations in terms of physical, technological, and human resources. The framework standard must be flexible enough for the standards derived from it to be

28 Guidelines for the Surveillance and Control of Drinking Water Quality

able to select their parameters and adjust their values while respecting the limits. expressed in the framework standard. This will lead to the application of differentiated standards for the different regions of the country and even for distinctions between large urban supply systems and those designed for small communities.

A good way of achieving flexibility in the values of the framework standard parameters is by classifying them under "desirable values" and "maximum permitted values" (MPV). The desirable values would be the “Guide Values” (GV) recommended in the WHO "Guidelines for Drinking-Water Quality”. The “maximum permitted values" (MPV) would define the quality of the drinking water as that which may be consumed with a greater risk to public health than that corresponding to the guide value, but which has been defined based on the efficiency of the treatment facilities and of the human, economic, and material resources of the country. In the surveillance tasks, under no circumstances may the MPVs be exceeded.

Likewise, under the authority of the law, it could be possible to establish provisional standards, authorized diversions, periods of grace, and even exemptions, as part of a national or regional policy. This would give a margin of flexibility and enable water suppliers to meet the quality goals in stages, thereby preventing local initiatives or private interests from unilaterally imposing their criteria on the quality of drinking water.

In this way the surveillance authorities and the water supplier will be able to design clear strategies for setting gradable goals on water quality. A program based on modest but realistic goals and which includes few parameters but accessible ones, and at the same time provides a reasonable degree of protection for public health, is nearly always more effective than an over-ambitious program.

2.2.2 Resources

a) Human resources

The quality of the information produced by the supplier or by the surveillance body depends on the work carried out by the staff responsible for analyses, sanitary inspections, data processing, etc. It is therefore essential that staff members be trained to do their jobs properly. Good training will ensure that data are produced using standardized procedures, thereby allowing the data to be compared validly by the different persons and units involved in the surveillance and control work, and facilitating the systemizing of information at the regional and national level.

The surveillance body and the supplier should therefore design effective strategies for the ongoing development of their human resources, identifying for the different organizational levels the responsibilities, job descriptions, professional career structure, and staff motivation mechanisms.

Elements of Surveillance and Control 29

Staff needs for the implementation of a surveillance or control program in water supply services vary a great deal and there is no reliable method of determining the number of staff members necessary to serve a given population, or the number needed for taking a given quantity of samples in different kinds of water supply systems. To estimate needs in terms of human resources, we have to take the following factors into account:

• Distance from the operational headquarters to the different sampling points or water supply systems. • Condition of roads. • Geomorphology of the area. • Town development; population density. • Size and complexity of the supply system. • Type of vehicle used. • Climate. • Sampling facilities; information about the sanitary condition of the components. • Cooperation of the community in sampling and information. • Degree of training of the staff responsible for evaluating the water supply systems. • Frequency of sampling. • Types of analyses to be performed on site or in a laboratory.

b) Material resources

Under this heading we need to consider the laboratory facilities and support materials available, such as vehicles and other ancillary facilities conducive to task compliance.

As for the laboratory, whose job it is to identify the physical-chemical and microbiological characteristics of water samples obtained in the supply system in order to determine the appropriateness and safety of the treatment and distribution processes, this is the area which calls for the greatest resources – both human and financial – so laboratory work must be carried out based on a concept of efficiency and effectiveness.

In fact, the efficiency and effectiveness of the laboratory will be measured by the prompt performance of the analyses and reporting of results, as well as by the reliability of the results. To comply with this last point, a system will need to be put in place to monitor the analytical quality and guarantee the accuracy of the analytical results. The quality of the analytical information will have a direct repercussion on the identification and effectiveness of the corrective steps to be taken in order to amend defects in the supply system which have given rise to the deterioration of water quality.

With regard to equipment, the laboratory should have a variety of materials congruent with the level of surveillance or control planned for the country, region, or locality. Generally speaking, laboratory materials fall into the following categories:

• Equipment and instruments. • Furniture.

30 Guidelines for the Surveillance and Control of Drinking Water Quality

• Reagents for physical chemical analyses and culture media for bacteriology. • Laboratory glassware. • Miscellaneous materials and calibration reagents.

In principle, analyses should be carried out in a laboratory as near as possible to the place from which the samples are obtained, in order to reduce to a minimum the risk of their being altered during transportation, mainly in the case of the microbiology samples. An added advantage is that the closer the laboratory, the lower the transportation costs.

Whenever it proves impossible to implement laboratories with an ample analytical capacity, modest laboratories may be used, in which a relatively small number of simple determinations are carried out, especially of critical parameters. In such cases, tests for heavy metals and organic compounds are referred to specialized laboratories. Normally, the number of determinations per year of heavy metals and organic compounds is small; besides, this type of analysis calls for sophisticated equipment and highly trained staff, very rarely found in small laboratories.

With reference to the organization of a system of surveillance laboratories, it will nearly always be necessary to have a structure based on a central laboratory, a certain number of regional laboratories, and a series of basic laboratories at the district level. This structure may be complemented with staff using portable equipment to make on-site measurements of the most important parameters, as a means of ensuring greater decentralization and coverage.

The central or referential laboratory should be an accredited one or, in its defect, one certified by an organization of recognized prestige in the region or worldwide. It should be equipped to deal with the whole series of parameters set down in the quality standard for drinking water. The central laboratory, besides complying with these tests and fully guaranteeing the quality of its own analyses through a quality assurance program, should also be responsible for performing external control on the quality of the analyses performed by the smaller laboratories.

The regional laboratories should be capable of carrying out a moderate series of physical- chemical and microbiological analyses, which must be subject to quality assurance programs to guarantee their quality. In addition they should have the capacity to offer support services to the district laboratories or to the staff carrying out tests using portable equipment. Figure 3 shows the recommended analytical capacity of the different types of laboratories entrusted with the sanitary surveillance of drinking water quality.

Another element of the utmost importance in the tasks of surveillance or control of drinking water quality is transportation. The means of transportation must be suited to the climate, terrain and local customs. The different options include using four-wheeled vehicles (normal or four-wheel drive), motor-cycles, bicycles, beasts of burden, boats, as well as going on foot. One of the criteria to determine the most suitable means of transportation is the time that will elapse between the taking of the samples and their arrival at the laboratory. The operational and maintenance costs of the different means of transportation will also have to be taken into account, as well as their service life.

Elements of Surveillance and Control 31

In different areas a duly conditioned motor-cycle has proven highly adaptable to the requirements of programs for the surveillance and control of drinking water quality. Motor-cycles can usually carry both the portable equipment for analyses and the training material; they are a far cheaper option; they can take the staff quickly from one point to another over any kind of terrain; and, last but not least, they are less likely to be pressed into service by other departments.

The staff must also be provided with everything they need to discharge their duties, such as identification, the right kind of clothing for the climatic conditions of the work area, facilities for the preservation and transportation of water samples, and office supplies that enable them to record information in situ.

c) Economic and financial resources

The central or regional governments normally finance the institution responsible for sanitary surveillance at the national or regional level, as part of the country's policy to safeguard the health of the population.

In large cities, where there is a corporation responsible for the water supply, a large portion of the cost of sanitary surveillance is usually assumed by the supplier, taking advantage of the results of activities undertaken for the quality control of the water it supplies. In such cases, the cost of the sanitary surveillance is automatically passed on to the customer in the water rate.

In the surveillance and control of small and medium-sized rural water supply systems, where the cost-benefit ratio is far higher than in larger localities, strategies must be adopted to reduce surveillance and control costs to a minimum, mainly in the budget lines of laboratories, staff, and transportation, which are normally those that demand the highest expenditure. One strategy in this context is to make use of the organizational structures already existing in the communities, for example the committees responsible for managing the water supply systems, and the community health promoters.

Frequent trips to rural communities to take water samples or to inform community authorities about the condition of their water distribution infrastructure are expensive, so every effort should be made to reduce trips to a minimum. In such cases, the possibility should be evaluated of having staff spend the night in the communities, and using portable water analysis equipment in situ. In this way, before leaving the community, the staff member entrusted with the surveillance and/or control will be able to give the results of the evaluation to the community authorities right away, for them to take the necessary corrective measures to improve the quality of the water in the supply system.

Besides, an overnight stay in the community often provides a good opportunity for the surveillance staff to train the members of the community's administration committee in aspects of management of the water supply system and to train the community health promoters in aspects of health and hygiene.

32 Guidelines for the Surveillance and Control of Drinking Water Quality

Analytical capacity

Central Complete physical, chemical and microbiological laboratory analyses and organic components

Regional Limited physical and chemical analyses and laboratories complete microbiological

District laboratories or Analyses of chlorine residual, turbidity, pH, portable equipment conductivity, total coliforms, thermotolerant coliforms

Figure 3. Example of the Analytical Capacity of the Laboratories of the Surveillance System

2.2.3 Training

The success of programs for the surveillance and control of water quality depends on the quality and quantity of the human resources, so it is essential that ongoing training programs be designed and conducted. Training, as opposed to "education," is a non-formal process of permanent self-teaching, and therefore its objective is the growth of the individual, the development of his or her faculties, creativity, and professional and social values. This integral human growth of an individual directly benefits the institutions in which he or she works. For that reason, the training mission is to offer guidance and training to all staff members involved in surveillance and control work, as well as to community health promoters and those who carry out administrative functions in rural communities, to encourage them to support the water quality surveillance and control activities.

The training should provide the knowledge and skills required for proper compliance with the various tasks. It should enable the trainees to reach institutional objectives and meet their individual goals, teaching them to ensure a good quality of drinking water by means of planned, permanent actions. Training should also include management practices and technical skills, in keeping with the decentralization and other innovations proposed by state modernization schemes.

Keeping the surveillance and control staff updated calls for institutionalization of the training activity. Suitable premises will be required, as well as offices, a sufficient number of trained technical staff, a budget to cover the permanent organization and conduction of quality events, and a sufficient number of such events to guarantee the transfer of technology to those

Elements of Surveillance and Control 33

responsible for surveillance and control tasks. These training programs should be planned for implementation on a continuous and repetitive basis in order to keep the present staff updated and to train new staff replacing the former as they may leave the company for retirement or other reasons, or are transferred away from the unit in charge of surveillance or control of water quality.

The areas where training should normally be given are:

• Surveillance and control − Basic concepts − Planning − Execution − Sanitary and operational inspection • Sampling − Taking samples − Preservation − Identification • Transportation • Handling of portable equipment for analyses • Water analysis − Physical − Chemical − Bacteriological • Analytical quality control • Processing of information • Identification and selection of preventive and corrective measures • Audits − Sampling − Analysis − Sanitary and operational inspection − Institutional • Drafting of reports

2.2.4 Sanitary Education

Education is a formal process whereby persons develop as human beings, individually and collectively, in a specific cultural environment. In this context, sanitary education programs are designed to create in the population the desire to have safe water supply systems and to keep them properly maintained so that they will have a long service life. This motivation is achieved by raising the people's awareness of the correct way to use, store, and handle water at the consumer level to conserve water quality and make rational use of the water. These aspects are complemented by topics of hygiene in food-handling, hygiene in the home, personal hygiene, and disposal of excreta. The main goal of sanitary education is to help reduce water-related

34 Guidelines for the Surveillance and Control of Drinking Water Quality

diseases. The fields of action of sanitary education vary according to the type of environment — urban, periurban, or rural.

In a rural environment, education on hygiene can cover many activities based on the behavior of the community, the local climate, and the diseases prevalent in the area. In planning sanitary education on the subject of hygiene, the first stage should consist of a dialogue with the community and local organizations themselves, to identify the behavior of the community with regard to hygiene, and to assess the possible impact of the sanitary education program on the previously identified behavior patterns. The team drawing up the plan of action for education on hygiene needs to obtain answers to the following questions:

How can we motivate community participation? What is the target group to which the education is directed? What should the contents of the education program be? Who should impart the education on hygiene? What teaching methods should be used? What kind of support should be provided by the surveillance body?

During educational campaigns in rural areas, we need to bear in mind that hygiene-related behavior patterns are particularly difficult to change for three reasons: they are linked with routine daily activities, they are common to the whole community, and they form part of the local culture and traditions. It must be realized that the improvement of the water supply service, and of sanitation and hygiene form part of an integral process of community development. It is therefore important to work with all members of the community, and in particular with the schoolchildren. The whole community should be urged to participate in all phases of the education campaign. If effective didactic methods are used, the people will be sufficiently motivated by the training to assimilate and adopt new habits of hygiene and sanitation.

Hygiene education should focus on the following behavior patterns:

• Preservation of water sources • Water collection • Water storage • Protection of the water for human consumption • Use and conservation of water in general • Handling of food • Disposal of excreta • Disposal of sewage

However, it is sometimes more effective to focus on a minimal number of behavior patterns, rather than attempting to improve all those listed above at one time. Behavior patterns should be selected for attention based on the probable benefits that their modification or improvement will contribute to public health or the health of the community. In all probability, the greatest benefit to the health of users of rural and periurban water supply services will be

Elements of Surveillance and Control 35

achieved by having the education activities focus on those habits of hygiene that the surveillance work has revealed to require priority attention.

2.2.5 Surveys

Surveys are applied to determine the physical, administrative and operational conditions of the water supply systems. They enable us to identify risk factors, both material and human, that have an impact on water quality, water treatment and distribution processes, administrative and institutional aspects, and levels of hygiene — with particular emphasis on sanitation-related habits of hygiene.

Surveys are made up of several sections designed to evaluate each of the physical parts of the water supply system or the relevant institutional or administrative aspects, for either the surveillance or the control program. The survey designers should take care that the questions to be asked are as few as possible and that they are directly related to the objective of the surveillance or control activities. Moreover; each question on the survey should be examined to check its relevance to the objective of the work. The attempt is often made to take advantage of the surveys to obtain additional information, of doubtful value, and this merely hinders the act of gathering of information, with the consequent loss of reliability of the answers or results obtained. Finally, the questions must be precise and worded in such a way as to minimize misinterpretations on the part of the surveyor.

The types of survey forms usually applied in the drinking water surveillance and control programs are outlined below:

• Basic data on the water supply system and physical characteristics of each of the components it comprises; • Referring to each of the components, its physical aspects that jeopardize or may jeopardize the conservation of the quality of drinking water. These characteristics are listed on the sanitary inspection form; • Indicators designed to evaluate the quality of the water and of the supply service. These cover the aspects of physical, chemical and microbiological quality of the drinking water at the outlets from treatment plants and at supply sources (surface or ground), intake components of the distribution system and the distribution network. • If possible, evaluation of the water quality in customers' homes and surveys, to determine the habits of hygiene of the beneficiary population. The latter point will probably be of greater relevance in the case of low-income sectors of the population and in small and medium rural communities. • Indicators of the operational management of the different components of the water supply system; and indicators of the administrative management of the water quality control program.

36 Guidelines for the Surveillance and Control of Drinking Water Quality

2.3 Information

2.3.1 Application of the Surveillance Information

Not only is the information obtained by the surveillance body useful in assuring the quality of drinking water by protecting the consumer from the presence of harmful pathogenic, physical and chemical agents in the water; but in addition the processing of all the surveillance information produces complementary benefits. Among the most useful are the ability to identify the need for a) expansion of the basic sanitation infrastructure, b) rehabilitation of the water supply system, c) training requirements for the staff involved in the operation, maintenance and administration of the water and sanitation services, d) measures to prevent and mitigate pollution of water sources, e) updating the regulations, standards and codes of practice relating to the preservation and conservation of drinking water quality. Also, a regional or national data base facilitates the identification of needs in the water and sanitation sector and can therefore be a valuable tool in planning the country's future investment in extension of coverage, improvement and rehabilitation of water supply services, training, etc.

• Improving the service: The permanent monitoring of water quality helps ensure that the distribution system as a whole is working satisfactorily and providing a product that complies with drinking water standards.

• Rehabilitation of the system: As in the above case, both the surveillance and control of water quality lead to the identification of any physical areas of the supply system where there may be deficiencies that normally necessitate corrective measures. This identification will subsequently be translated into the execution of projects for the repair or reconstruction of the water supply system.

• Investing in water supply: The information obtained from the surveillance and control activities can also be used in planning projects for the extension, improvement and rehabilitation of the water supply services, as well as in determining the respective investment required at the national and regional level.

• Training: The recontamination of water for human consumption is a consequence of activities carried out by the supplier, mainly during the operation of the water supply system or routine maintenance work. This recontamination of water is usually associated with the use of wrong procedures, owing to insufficient knowledge on the part of the staff responsible for applying sanitary procedures to conserve and preserve the quality of water within the distribution system.

• Updating the drinking water quality standards: The goal of the quality standards for drinking water, is to ensure the removal – or reduction below levels harmful to human health – of harmful microorganisms and substances, for the well-being of the community. Surveillance has as one of its objectives the revision and periodic adjustment of these quality standards to guarantee that the public will be supplied with safe water, free from any danger,

Elements of Surveillance and Control 37

harm or risk to human health. The surveillance information can also be used to revise and update the regulations and codes of practice for the conservation and preservation of drinking water quality in the aspects of design, construction, operation and maintenance of the water supply systems, including the building materials and chemicals that can be used in the implementation and operation of water services.

• Preservation of water courses and bodies: As in the above case, the information obtained on drinking water quality can help in the definition and adoption of national policies for the protection or the contamination of water courses and bodies.

Figure 4 shows how the surveillance and control information can be used in the improvement of the quality of water and water supply services.

2.3.2 Information Flow

Communication between the water supplier and the surveillance body must be completely fluent and unrestricted; there must be permanent dialogue. The water supplier is under the obligation to report to the local, regional or national office of sanitary or operational surveillance, as the case may be, all the information obtained in the execution of its water quality control program in the supply system it administrates. For its part, the sanitary or operational surveillance body must perform strict follow-up, in particular on the procedures used for obtaining information in the field, sampling, analytical methods used on the water samples, data management, among others, in order to verify the accuracy of the results and their compliance with the regulations set by this body.

There should be a mechanism in place to allow information to flow faster in cases of emergency and/or force majeure, to ensure effective coordination so that corrective measures may be taken jointly and opportunely. Such an impact is highly beneficial for both institutions because the population attended to will see for themselves that joint efforts are being made by the water supplier and the surveillance body to safeguard the people's health and well-being. Figures 5 and 6 show models of information flows originated by the supplier and by the surveillance body.

At all times the supplier must be careful not to conceal information and the surveillance body must refrain from acting as an inquisitor, because this could lead to a strained or conflictive relationship between the two institutions. Worse still, if the two belong to different sectors, it may lead to problems of a political nature, which could seriously tarnish the water supplier's image.

National sur- National institute

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r r p Rehabilitation of Improvementin Extension of p procedures infrastructure service coverage NationalNational and and

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Figure 4. Use of Information Obtained from Control and Surveillance of Drinking Water Quality

Elements of Surveillance and Control 39

2.3.3 Data Processing and Reports

The processing of data produces information and it is the use of this information generated by the surveillance and/or control program which enables rational improvements to be made to the water supply systems, the term rational implying that the human and economic resources available are used with maximum efficiency for the benefit of public health.

The information obtained by the supplying company on the quality of the water it supplies and any defects that may have been encountered in its water supply system (information resulting from the sanitary inspection) must be properly validated to make sure that the data to be processed reflect as faithfully as possible the quality of the water supplied and the condition of the infrastructure. In the validation process, information that is immaterial or inconsistent from an analytical point of view (physical-chemical or microbiological analyses) may be discarded, as well as data inconsistent from a qualitative or appreciative point of view in the case of validation of sanitary inspections; so that the information to be processed and analyzed will be completely reliable. The process of validation of analytical information is carried out by means of quality assurance and quality control tests, while the validation of the sanitary inspections is performed by means of random re-inspection of a percentage of the facilities assessed.

The acceptable or reliable results should be stored in a data base, and special programs will be used to classify the information and correlate it in order to identify problems and their causes. This will make it possible, in turn, to identify the pertinent corrective measures.

In addition, the water supplier should classify the validated information per main component of the water supply system, namely: water source, outlet from the treatment plant and/or sources of groundwater, outlet from components of the distribution system, distribution network and user connections. The information should be processed at different levels: scientific, professional, management and public, each of which has a clearly defined individual focus.

Normally, the scientific level has the whole data base at its disposal, and work at this level consists mainly of using the information to find explanations for cases or phenomena that are difficult to interpret. Information at the professional level is mainly operational, since it facilitates prompt identification of defects or problems in the water supply system. Management level, as its name indicates, is information used by top management of the company to define the strategies and actions that will lead to an improvement in the water supply service. Finally, public-level information is directed to making the customers aware of the quality being provided by the supplier. The report containing public-level information should be considered a support tool for the Public Relations area.

40 Guidelines for the Surveillance and Control of Drinking Water Quality

Planning Monitoring

Sanitary Inspection Sanitary Quality Alert

Normal High High Risk Low Risk No Risk results results

Validation of information

Acceptable results

Data base

Processing of Problem Immediate information identification intervention

Reports

Surveillance Corrective Institution body measures

Figure 5. Information Flow-Supplier

Elements of Surveillance and Control 41

National authority

report

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National data base Central surveillance Regulating entity Report

Follow-up

Feedback Annual report Report summary Annual report Regional data base Regional surveillance Regional supplier Follow-up

-up -

Report Follow Feedback Report summary Annual report Local records Local surveillance Follow-up Local supplier

Follow-up

Report Feedback

Rural controller Rural system Report

Inspection

Figure 6. Information Flow Surveillance of the Quality of the Water Supply Services

42 Guidelines for the Surveillance and Control of Drinking Water Quality

2.4 Sanctions

The surveillance function should essentially be one of support, notification and caretaking, and only in the last resort a function of sanctioning of failure to comply with standards. Nevertheless, the legal framework must specify penalties, including fines for isolated and repeated infringements, and it must clearly state that the administrators or directors of the water supply institution will be held personally responsible for serious offenses causing a negative impact on the health of the consumers, in cases where it is demonstrated that the deterioration in water quality was due to acts of negligence or mismanagement on the part of the staff responsible for managing the water supply system.

Although the scope of the surveillance program is to assure the quality of the water supplied and the adoption of measures required to correct any deficiencies observed, thereby safeguarding consumers' health, sanctions should also include the protection of suppliers in the event that they are unjustly held responsible for supplying water of an inferior quality.

Finally, the sanctions should also consider cases in which the suppliers refuse to submit periodic reports to the surveillance body, or to notify the population of certain measures to protect their health when emergency situations arise, as in the event of accidental contamination with bacteria or chemicals.

3. Methodologies

3.1 General

3.1.1 Surveillance and Control Levels

When drawing up sanitary or operational programs for the surveillance or control of water quality, the program designers must take existing resources into account: laboratories, network of laboratories, qualified staff, financial support, transportation facilities, etc. The availability of these resources, and the legal devices already in place relating to water quality (standards or regulations) help to define the level of quality control that the water supplier can undertake in its area of service, and what the sanitary surveillance body can demand in the country, or in a given region or community.

To begin with, sanitary surveillance and control programs can be simple, low-cost and high-impact programs executing only the sanitary inspections on the physical works that make up the water supply system. This type of inspection makes it possible to identify the main defects of the components, which represent a risk for the preservation and conservation of drinking water quality within the supply system. Subsequently, they can be complemented with determinations of chlorine residual and other basic operational parameters such as turbidity, pH, etc. These last mentioned determinations can be started at the intake reservoirs, to continue afterwards with the different components of the distribution system, and subsequently cover the primary networks as far as the secondary network level.

Methodologies 43

Once the basic parameters mentioned above have been started and consolidated, the inspection can then proceed with total and thermotolerant coliforms in the same sequence indicated above, and if there is a laboratory for physical and chemical analyses, the volumetric analyses and some simple colorimetric ones can be effected, until eventually the more complex analytical determinations, such as heavy metals and organic compounds, can also be covered.

Bearing in mind the above, we can establish five levels of surveillance or control ranging from an “initial” level, applicable in the countries, regions or communities where there is very little experience in these types of programs, to a “complete” one, similar to those implemented in developed countries or regions, where water-related diseases have been brought under control.

It is important, when defining the level of surveillance and control, to take into account the real situation of the control programs available to each of the water supply services, and the capacity of response of the institution responsible for surveillance at the national and regional levels, so as not to exceed their capacities of response. Once efficiency and effectiveness have been achieved at the level of work adopted, it will then be possible to move up to the next level, but under no circumstances should an attempt be made to go on to levels beyond the capacity of response of the institutions involved; such attempts nearly always result in failure. The competent authorities' scheduling and rescheduling of levels as described above should be repeated until the desired goal is met.

Table 3 shows a matrix linking the institutional situation and the levels of surveillance proposed above, and Table 4 identifies the main activities undertaken for surveillance and control of drinking water quality at each of the five levels. Table 5 shows the main requirements to be met for each level of surveillance or control.

Table 3. Proposed Levels Based on the Institutional Situation of The Country or Region

Level Situation of the country or region I Initial No formal program and no pertinent authorities II Basic Minimal program with seriously limited scope and efficiency III Intermediate Program applicable to large cities Program applicable to large and medium-sized cities and, with some constraints, to rural IV Advanced communities Programs similar to those employed in the countries or regions where water-borne diseases V Complete have been brought under control

44 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 4. Activities per Level of Intervention for the Surveillance or Control of Drinking Water

Level Activity I II III IV V Sanitary inspections in components of the distribution system X X X X X Elementary analytical parameters in components and primary networks X X X X X Elementary analytical parameters in secondary networks* X X X X Quantification of indicators of microbiological quality in components and X X X X primary networks Quantification of indicators of microbiological quality in secondary networks X X X Quantification of indicators of microbiological quality in sources and homes X X X Basic physical and chemical analysis X X X Intermediate physical and chemical analysis X X Complete physical and chemical analysis X * Elementary analyses refer to pH, turbidity, chlorine residual and organoleptic characteristics.

3.1.2 Scope

Since there is a considerable difference between integral planning for surveillance in general and the control of water for human consumption, and between urban and rural surveillance work, in this document we define the methodological procedures for each type.

Generally speaking, in the planning of surveillance and control activities, the following aspects must be taken into account:

• Identification of the basic characteristics of the water supply system • Water quality standards, with emphasis on analyses to be effected, frequency of sampling, sampling points, etc. • Execution − Evaluation of the water quality − Sanitary and operational inspection − Institutional inspection − Assurance of quality of the information • Processing of the information • Identification of corrective measures • Reports

Methodologies 45

Table 5. Principal Requirements per Level of Intervention

Activity Level I II III IV V Laws and regulations Elementary Basic Intermediate Advanced Complete Sanitary risk, Sanitary risk, Sanitary risk, bacterial bacterial Sanitary risk bacterial Scope of water quality parameters, and parameters, and Sanitary risk and bacterial parameters, and standards intermediate advanced parameters basic physical- physical- physical- chemical chemical chemical

Staff responsible for Untrained Trained Intermediate to Basic Intermediate surveillance and control Basic Basic highly trained

Trained Operators of water Untrained Intermediate to Basic Basic Intermediate installations Basic trained

All urban cities Application of sanitary Main and All urban cities Large cities Main cities and some rural surveys medium cities and rural towns towns All urban cities Approval of sources of Main and All urban cities None Main cities and some rural water medium cities and rural towns towns All urban cities Main and All urban cities Sampling Main cities Main cities and some rural medium cities and rural towns towns Basic Intermediate Complete Bacterial and Residual microbial microbial and Standardized methods* Residual bacterial, Chlorine physical physical chorine physical chemical chemical chemical Basic non- Regional Portable Basic specialized Laboratories** Analysis kits specialized specialized laboratories laboratories laboratories laboratories Standards for the design None Basic Elementary Intermediate Complete of water systems Standards for building None Basic Elementary Intermediate Complete materials Complementary regulations (water tanks, None Basic Elementary Intermediate Complete bottled water, etc.)

* Bacterial determinations include mainly total and thermotolerant coliforms, and microbiological determinations include the identification of protozoa, helminths and other aquatic microorganisms ** From intermediate level upward it is required to have a Central ("Reference") Laboratory.

46 Guidelines for the Surveillance and Control of Drinking Water Quality

The methodologies proposed normally aim at:

• Determining the quality of the drinking water supplied by the companies or institutions providing the water supply service. • Identifying any sanitary defects in the different components of the supply system that may represent a risk to the conservation and preservation of drinking water quality. • Evaluating the effectiveness of the treatment plant's processes for surface water or groundwater. • Identifying the corrective procedures for the re-establishment and/or improvement of the drinking water quality. • Evaluating the institutional capacity of the supplier to carry out the water quality control. • Identifying the localities and areas of supply that are the most vulnerable and pose the highest risk to the health of the users of the water supply services. • Planning the sampling programs of the surveillance body to validate the information provided by the supplier. • Auditing the activities of the supplier in connection with the quality control of the water supplied to the population and other aspects of the operation and maintenance of the service. • Supervising the application of corrective measures. • Improving the water quality standards, and regulations relating to building processes and materials employed in the building of the water supply systems. • Certifying the quality of the water consumed by the population served by the supplier. • Processing the information provided by the supplier. • Planning investments for the extension, improvement or rehabilitation of water supply services.

3.1.3 Fields of Action

The fields of action for the surveillance and control of drinking water quality, in both urban and rural areas, are the following:

• Source: Depending whether the water is of surface or ground source and on the natural or artificial factors affecting its quality, the source of water supply can have an impact on the health of the consumers and special attention should be paid to protection, quality, and treatability. The sources are mostly raw waters of rivers, lakes, dams, wells, filtration galleries, and springs.

• Treatment plant: The treatment plant's efficiency in removing the compounds that affect the acceptability of the water for human consumption and human health is influenced by the quality of the raw water and, in particular, by the operation, maintenance and control of the treatment processes, which need to be more rigorous in the case of highly contaminated sources. At this level, consideration can also be given to the treated water that is supplied to the distribution network by wells, filtration galleries and springs.

Methodologies 47

• Water distribution system: The water treated and distributed through the supply system should be preserved and conserved until it is delivered to the customer, to ensure that it complies with physical, chemical and microbiological standards, that it is safe for human consumption, and that it therefore represents no danger to the health of the customers.

• Consideration is given to the evaluation of: − components of the distribution system (reservoirs, pumping chambers, supply pipes, etc.), and − the distribution system itself.

• Intradomiciliary: In urban areas this aspect is not usually considered in quality control programs, since the responsibility of the supplier goes no further than the limits of the customer's property. However, it is often to the supplier's advantage to carry out evaluations in the home, to clarify liabilities.

In rural areas, mainly in those places where water quality is evaluated only very sporadically and the evaluating institution plays the double role of surveillance body and controller, sampling should be carried out in people's homes as a routine part of the evaluation, as this will help identify the reach of the sanitary education programs.

In addition, in the specific case of surveillance, the following aspects should be considered:

• Audit: To be able to accept unconditionally the information obtained by the supplier, the surveillance body will have to implement a mechanism to verify the information and the degree of compliance with surveillance regulations regarding frequency of sampling, parameters and number of determinations, types of sampling stations, analytical quality control and validation of all the information obtained by the supplier.

• Validation: Periodically the surveillance body should make an operational and sanitary inspection of certain components and take samples at certain fixed points of the water supply system in order to verify that the operation and maintenance activities, the sanitary inspection and the analytical results do not differ materially from the data reported by the supplier.

• Epidemiology: The surveillance body should gather and process the information from the epidemiological surveillance obtained by the pertinent authorities, and identify and select all those diseases related with water quality.

• Investigation: The surveillance body should process the information provided by the supplier and the epidemiological data supplied by the competent authorities, and determine whether there is any link between the water quality and reported cases of waterborne diseases. If such a link is detected, the surveillance body must proceed to recommend corrective measures to be applied by the supplier and, if deemed appropriate,

48 Guidelines for the Surveillance and Control of Drinking Water Quality

these measures may be incorporated into the standards, regulations or specifications for the design, operation, and maintenance of water supply systems.

• Control of water quality in areas under communal management: In places that are not served by a water supplier, the Health Authorities assume responsibility for carrying out control of the quality of drinking water and act through the administrations, community leaders, or municipalities, for the execution of corrective actions. To prevent interference and misunderstanding within the Health Authorities, the institution that carries out the control activity must act independently from the organization responsible for sanitary surveillance, thereby reducing to a minimum the subjective influence of a two-fold antagonistic function.

3.2 Surveillance Plan

A surveillance plan usually consists of a series of programs, sub-programs, activities and tasks to be implemented in execution of a project or development. The plan does not provide a detailed description of the contents of each activity identified; rather, it is more like a set of ideas, properly justified, that give a clear notion of the sequence to be followed in order to achieve the desired goal, the benefits to be obtained, and an estimate of the cost involved.

The drawing up of a Surveillance Plan should consider four aspects: a) diagnosis; b) the plan itself; c) intervention possibilities; and d) investment.

3.2.1 Diagnosis

The diagnosis seeks to obtain an understanding of the geographic, economic, cultural, and health scenario of the country, and to present the legal framework with respect to the laws, regulations, standards, etc., associated with surveillance and control activities. This chapter could be structured in the following way:

• The country: − Population and its distribution − Populated centers − Population growth − Situation of water supply services

• The health situation: − Health indicators − Prevalence and incidence of diseases related to the quality of drinking water and sanitation; their impact on the country's economy − Attention by the Ministry of Health

• Preventive health programs: − Health programs − Investment in preventive health

Methodologies 49

• Surveillance and control: − Legal framework (laws, regulations, standards, etc.)

• Prevention of transmissible diseases by providing an adequate supply of drinking water: − Surveillance and control programs − Evaluation of the surveillance and control system

3.2.2 The Plan

The field of action of surveillance and control is defined in detail. This chapter could have the following contents:

• General (summary of the plan itself)

• Main goal and specific objectives

• Strategies

• Hoped-for results

• Fields of action: − Sources of supply − Production − Distribution network − Operational and institutional evaluation − Etc.

• Scope of the surveillance and control program − Levels of surveillance: ° Water supplied by distribution networks (urban and rural) ° Water supplied by public faucets, tank trucks, or individual sources − Analytical determinations: ° Outlet from treatment plant ° Components of the distribution system and primary network ° Distribution system ° User connections − Frequency of sampling: ° Bacteriology ° Physical and chemical ° Sanitary inspections

• Programs − Operational

50 Guidelines for the Surveillance and Control of Drinking Water Quality

1. Water analysis ° Quality standard ° Laboratories − Minimum equipment − Quality control ° Sampling − Procedures − Sampling points ° Analysis procedures 2. Sanitary inspection ° Populated centers (with and without supply systems) − Urban − Rural ° Inventory of treatment facilities and of components of the distribution system ° Risk evaluation procedures (sanitary inspection) 3. Institutional evaluation ° Institutional organization ° Operational capacity − Support 4. Information ° Information Flow ° Data base ° Evaluation − Water quality − Level of service − Level of risk 5. Institutional development ° Institutionalizing the surveillance system ° Follow-up and notification system ° Strengthening the institutions responsible 6. Legal bases ° Revision and updating of legal standards to adjust them to the scope of the surveillance plan 7. Development of human resources ° Identification of staff engaged in the surveillance and control of drinking water quality ° Quantification of staff requirements ° Training needs ° Development of training material ° Design of the training program 8. Environmental education ° School education ° Community education

Methodologies 51

9. Epidemiological surveillance ° Notifiable diseases ° Correlation of water quality information and epidemiological information 10. Community surveillance (rural and periurban level) ° Surveillance Committees

3.2.3 Intervention Possibilities

Technically viable intervention possibilities must be identified, based on the following considerations: the objectives of the sanitary surveillance intervention, range or scope of the operational and support programs, capacity of existing laboratories, number of professionals and their degree of qualification, economic resources, situational status of the surveillance and control programs and, above all, the standards and regulations currently in force on drinking water quality.

3.2.4 Investments

Each of the previously identified alternatives should be quantified to determine its cost and inherent benefits. For this purpose, the following investment and cost aspects need to be examined for each alternative:

• Sanitary inspections • Analyses • Equipping of laboratories • Transportation • Salaries and wages • Others.

Based on the technical, economic and political analysis, the alternative most advantageous to the interests of the country or region is selected. Subsequently a more detailed analysis of the selected alternative and its scope and benefits is made. For this purpose it is recommended to analyze the following aspects:

• Characteristics of the selected alternative (detailed description)

• Investment and implementation cost of the selected alternative: − Sanitary inspections − Analyses − Equipping of laboratories − Transportation − Salaries and wages − Others.

52 Guidelines for the Surveillance and Control of Drinking Water Quality

• Origin and application of the financial resources to comply with the selected alternative: − Origin of the funds − Use of the funds.

• Execution of the plan (Implementation timeframe)

3.3 Water Quality Control in Urban Environments

3.3.1 Planning

Since the control of drinking water quality is a fundamental part of sanitary and operational surveillance in urban areas, the guidelines issued by the sanitary surveillance body and the regulating entity should take into account, besides current legislation, the following factors: operational capacity of the suppliers, laboratory and transportation facilities, and the availability of human and financial resources.

With the planning guidelines issued by the respective authority and the physical characteristics of the water supply system, the supplier can then proceed to draw up the strategy and define the activities required to implement the program for the control of drinking water quality. The activities or tasks to be executed at this stage are the following:

• Identification of the limits of the water supply areas. • Definition of sampling points and establishment of sampling criteria. • Selection of the analytical determinations to be executed in each of the components of the water supply system. • Determination of sampling frequency and of the number of analytical determinations. • Determination of the frequency of sanitary inspections. • Definition of staff needs. • Identification of complementary laboratory material. • Standardization of sampling and analysis procedures. • Training of the staff responsible. • Design or adaptation of the different forms to be filled out in the water quality control program. • Identification of sampling routes. • Establishment of the information flow. • Creation of data base for processing information. • Definition of data-processing method. • Definition of contents of regular reports. • Definition of sanitary education programs.

A guideline list in Annex 2 shows the main activities to be considered at this stage.

Methodologies 53

3.3.2 Execution

Once the planning stage is over, the program moves into the implementation stage. The first step is to verify the physical characteristics of each of the components of the water supply system. The facilities for obtaining water samples can then be installed. The sampling points in the water distribution network are identified. When this stage has been completed, permanent monitoring of the water quality begins in: a) sources and treatment plants; b) components; and c) distribution network; in addition to sanitary inspections effected in each of the components of the water supply system. All the resulting data start forming a core body of information for the water quality control program and will be made full use of by the bodies responsible for sanitary surveillance of the water.

This procedure can be applied in large, medium, and small urban centers, as well as in rural or periurban areas, by merely making a selection of the information deemed necessary for the particular type of program envisaged.

3.3.3 Data Processing and Reports

Once validated, the results of the laboratory analyses and sanitary inspections are processed in order to determine the quality of the water supply service provided by the supplier and to identify both the problems affecting water quality and their causes. This processing will make it possible to determine the most pertinent corrective measures.

The information must be classified in such a way as to afford an overall vision of the quality of the service based on the main components that make up the water supply system, such as: sources of water, outlets of treatment plants, outlets of components, distribution network and user connections if necessary. In turn, information processing must be carried out at the scientific, professional, managerial and public level, each one having a clearly defined characteristic.

Figure 7 shows in diagram form how to classify the input information, composed of data collected at the levels of office, supply installations, distribution network and laboratory, as well as the types of reports and results that need to be obtained as output information. This information should be managed automatically as far as possible and must reflect the most important aspects for the different levels targeted.

Executive report: This is a report in which global results are presented as well as results from each of the regions into which the water supply administration is divided, if such be the case. The report should contain the following:

54 Guidelines for the Surveillance and Control of Drinking Water Quality

• Sanitary condition of the components. • Main defects in the components of the water supply system. • Percentage of samples that comply with the minimum concentration of disinfectant.

Technical report: In addition to the executive report containing an overview of the situation of the whole water supply system, the results from each administrative region must be reported, clearly indicating points and areas where deficiencies have been detected, complemented by a representation of the historic behavior of each supply area. The contents of this report could be the following:

• Percentage of positive samples – total and thermotolerant coliforms. • Percentage of doubly positive samples in components and supply areas – total and thermotolerant coliforms. • Percentage of samples exceeding the limits established for chemical substances in the standards on drinking water quality – surface and ground sources. • Sanitary condition of the components • Condition of the supply areas with respect to water quality and continuity. • Main defects in the components of the water supply system. • Percentage of samples that comply with the minimum concentration of disinfectant.

Public report: This purpose of this document is to make known to the users of the water supply service the general characteristics of the service and the quality of water they are being supplied with. The information to be given at this level could be the following:

• Percentage of positive samples – total and thermotolerant coliforms. • Percentage of samples exceeding the limits established for chemical substances in the standards on drinking water quality – surface sources and ground sources. • Corrective measures taken.

3.3.4 Corrective Measures

The final result of the several tasks involved in drinking water quality control permits the identification of risks the water supply system can present and leads to a determination of the corrective measures that need to be taken to remedy the defects identified in operational and administrative aspects and in the infrastructure of the water supply system, from the treatment plant to the user connection, and in some cases (mainly in periurban or rural areas) inside the customers' homes.

Operational and administrative corrective measures will be translated into training programs, while at the customer level, the work is of a citizen education nature. Training is directed toward improving the skill of the staff responsible for performing the services; while the objective of the social outreach is to improve the habits and customs of the consumers by means of sanitary education campaigns.

Methodologies 55

Corrective measures at the level of the water supply infrastructure should be directed toward improving the quality of the water service by taking timely action to ensure the conservation and preservation of the water service in general and drinking water quality in particular.

I N O U T

Basic Results Inspection of Sanitary Information Analyses Operations Inspection Reports Results

Treatment Executive Sources Sources Components * Global plant (Global)

Treatment Treatment Water plant Components * System plant quality Storage Distribution Components * Administrative Sanitary reservoirs network areas quality Distribution Components * Technical Operational network (Specific) quality Distribution Intradomiciliary network Administrative Areas of risk areas Supply Corrective areas Components * measures Public Specific (Global)

Water System quality * Components: galleries, springs, wells, reservoirs, storage, distribution reservoirs, pumping chambers, tanks, pressure-relief stations, etc. Sanitary quality

Operational quality Areas of risk

Corrective measures Figure 7. Processing Information

3.3.5 Preventive Measures

It is possible that at the beginning of the water quality control program the activities resulting from recommendations will be of a corrective nature, and these corrective measures will continue until a sanitary consolidation of the water supply system has been achieved. Later, the control work will include follow-up to verify the conservation and maintenance of drinking water quality. It will establish the exact frequencies of application of preventive measures, mainly concerning the conservation and cleanliness of the supply system's infrastructure, but also with reference to preventive measures to be adopted in operational and administrative aspects, training and public relations.

56 Guidelines for the Surveillance and Control of Drinking Water Quality

3.4 Water Quality Control in Rural Areas

3.4.1 Introduction

Activities in rural areas are more complex than in urban ones, mainly because of the lack of a responsible supplier and the scanty supervision of water supply services by competent authorities. For this reason, on each inspection visit it is necessary to collect as much information as possible on the quality of the water service, the disposal of excreta and solid waste, and the habits of hygiene, among others, in order to evaluate the sanitary situation and identify the principal defects with a view to introducing the corresponding improvements. Normally, water quality control in rural areas is aimed at the evaluation of the service as a whole. The following main aspects need to be considered: a) Quality of drinking water b) Standard of service of water supply to the community c) Deficiencies in the components of the water supply system which can lead to deterioration in water quality d) Management of the water supply system e) Degree of sustainability of the water supply service f) Sanitary conduct of the customers; g) Programs of sanitary education leading to improvement in the health of the members of the community served h) Prevalence of diseases i) Economic impact.

3.4.2 Evaluation of Water Supply Services

The evaluation of the quality of the rural water supply service could include the identification of the following characteristics: a) General − Introduction ° Geographic location ° Population ° Accessibility ° Source

− Type of system ° Conventional − Gravity without treatment − Gravity with treatment − Pumping without treatment − Pumping with treatment ° Non-conventional − Community

Methodologies 57

° Artesian wells ° Protection of springs ° Others − Individual ° Artesian wells ° Springs ° Rainwater catchment ° Home filters ° Others b) Water quality − Concentration of coliforms − Concentration of chlorine residual − Turbidity − pH c) Quality of service − Quantity of water supplied (Waste) − Continuity of service − Coverage d) Management situation − Administration − Operator (permanent, part-time, none) − Operators’ and others’ pay − Commercialization (rate, extra charges) − Punctuality in payment e) Level of sanitary conduct of the customers − Personal hygiene − Hygiene in the home − Handling of water inside the home − Presence of animals in the home f) Prevalence of diseases (basic epidemiology) − Diarrheas − Skin and eye infections g) Level of deficiencies in the installations − Collection − Surface water − Groundwater ° Presence of people and animals ° Condition of the structure (cracks, leaks) ° Foreign elements inside the storage reservoirs

58 Guidelines for the Surveillance and Control of Drinking Water Quality

° Contamination of surface water upstream (latrines, dumping of solid waste, mining activity, etc.) − Treatment − Storage ° Access by people and animals ° Condition of the structure (cracks, leaks) ° Foreign elements in the interior − Adduction/Conduction ° Access of persons and animals to pressure-relief boxes ° Condition of pipes (leaks and cracks) − Distribution ° Access of persons and animals to pressure-relief boxes ° Condition of pipes (leaks and cracks) ° Condition of public sources − In the home ° Condition of user connection (faucet, drainage of domestic sewage) ° Gray water disposal.

3.5 Surveillance

3.5.1 General

The surveillance methodology proposed in these guidelines is feasible only if there is political support and a legal framework with clearly specified rules of the game enabling surveillance activities to be supported by the control activities of the supplier, and the two parties to coordinate work in conjunction.

In this way, the surveillance methodology described on the following pages is complemented by the methodology described above for drinking water quality control. In the case of rural or periurban localities not under the administration of a supplier, the surveillance body will have to identify an outside institution or an office independent from the sanitary surveillance work of its sector, to perform the quality control of the service. As far as possible, the surveillance body must abstain from carrying out the quality control of water of public or communal water supply services.

The responsibilities of the surveillance body are to: a) validate the sampling; b) audit the supplier; c) evaluate epidemiological information; d) manage information, investigation and risk evaluation; and e) follow up and develop the quality of the services.

3.5.2 Validation of Data

To validate the sampling carried out by the supplier, the surveillance body can apply the frequency values recommended in Charts A to E, Annex 1, affected by a factor that could be between 15 and 25 percent and which, according to sampling theory corresponds statistically to a

Methodologies 59

reliability level of no less than 95%. The surveillance body can accept, question, or reject the information provided by the supplier depending on the extent to which its own results coincide with those reported by the supplier. The analytical capacity of the surveillance body's laboratory does not need to be very great nor do large quantities of money need to be invested for it to discharge this responsibility.

3.5.3 Auditing

In addition to the previous task, it is necessary that activities carried out by the supplier to comply with its water quality control program be audited by an external institution appointed by the surveillance body. The audit will include an examination of the processes of collecting field information and water samples, and the procedures used for analyzing the water samples, to check whether the results and their records are reliable and whether they conform to the regulations of the surveillance authority.

It is considered essential that strict control be exercised over two basic aspects: a) analytical evaluations and b) results of sanitary inspections.

3.5.4 Epidemiological Evaluation

Epidemiology is a basic public health science which has as its objective the study of medical issues (health/disease) concerning the population as a whole and known as mass phenomena. These mass phenomena link the physical, chemical and biological environment with the human community and its environment. In the specific case of the sanitary surveillance of water quality, epidemiology helps to determine the causes of water-related diseases and leads to the identification and implementation of corrective measures.

From the epidemiological information provided by the specialized Ministry of Health department, the body responsible for sanitary surveillance of drinking water must select the diseases related exclusively to water in order to correlate them with the water quality records.

60 Guidelines for the Surveillance and Control of Drinking Water Quality

3.5.5 Management of Information, Risk Investigation and Identification

Surveillance has two main components: (a) the permanent and systematic examination of information on water quality to verify that the supply system is complying with established objectives and regulations; and (b) the correlation of physical, chemical and microbiological water quality with diseases related to drinking water quality, to determine the impact on customers’ health.

Since surveillance is an activity of investigation, it must be directed toward identifying and evaluating risk factors associated with water supply systems so that any corrective action required can be taken before health problems occur in the population. Surveillance also makes it possible to determine the causes or origins of outbreaks of diseases related to water quality in order to take the necessary measures to prevent them from spreading.

The procedure consists of a detailed examination of the basic information available, namely the results of analyses and epidemiological evaluation. The information will later be classified and grouped, taking into account the “cause and effect” aspect for further analysis.

Once classified, the information must be correlated with water-borne diseases. In this way relationships can be discovered between the diseases and water quality, sanitary defects, chemical products used in treatment and building materials used in the construction of the different elements of the water distribution system, in order to determine the supposed or possible impact of some of these factors on the consumers' health. In the processing of information, especially of bacteriological results, the many causes of transmissible diseases must be taken into account, paying particular attention to those originating in the food and the soil, so as to identify only those relating exclusively to water quality.

Based on the results of the correlation of risk factors with the quality of the water and the diseases relating to drinking water, we will be able to contribute criteria for improving the existing standards: standards on water quality, on the chemical products or substances used in water treatment, on building materials used in the construction of water supply systems, as well on the building procedures themselves, among others.

3.5.6 Follow-Up and Development

In addition to verifying compliance with the water quality standards, the surveillance body must observe, record and examine the information about water quality, chemical products used in water treatment, and operation and maintenance procedures. Also, it must continually follow up water quality to check for changes that may occur over time, and determine whether projections of these changes imply any impact on consumers’ health.

Methodologies 61

3.5.7 Periodic Reports

The systemized information on drinking water quality provided by the different suppliers must be distributed to all public and private institutions involved in public health, management of water resources and sanitation.

The report, normally published once a year, should give a summary of the water quality in the geographic area under the jurisdiction of the surveillance body, complemented with information from the smallest areas, which could coincide with the geopolitical divisions of the geographic area of intervention. The information at the level of the smallest areas will be a summary of the physical, chemical and bacteriological characteristics of the water provided by the different water suppliers.

The report should also contain general remarks on the quality of the drinking water, as well as a list of the programs to be implemented by the suppliers to improve drinking water quality. If possible, it should also identify the most urgent investigations that need to be made in the short term, as a way of contributing criteria for establishing the pertinent policies for the sector.

62 Guidelines for the Surveillance and Control of Drinking Water Quality

4. Bibliography

1. CEPIS (Centro Panamericano de Ingeniería Sanitaria y Ciencias del Ambiente). (1992). Control de Calidad del Agua de Lima. SEDAPAL. 2. European Community (1980/778/EC). The EC Directive relating to the quality of water intended for human consumption. DoE Circular 25/84. 3. Feachem, R. (1977). Water supplies for low-income communities in Water, Wastes and Health in Hot Climates. London, Willey. 4. Feachem, R. et. al. (1978). Water, health and development: Tri-Med Books Ltd., London. 5. Galal-Gorchev, H. (1986). Water Quality and Health. In Course on Surveillance & Control of Drinking Water Quality. Arusha, Nov. 1990. Centre for Developing Countries. Technical University of Denmark. WHO/DANIDA, 1990. 6. Geldreich, EE; Fox, K.R.; Goodrich J.A. et al (1992). Searching for a water supply connection in the Cabool, Missouri disease outbreak of Escherichia coli O157:H7. Water Res 26:1127- 1137. 7. ITINTEC. Instituto de Investigación Tecnológica Industrial y de Normas Técnicas. Norma Técnica Nacional. Agua Potable - Requisitos. ITINTEC 214.003. June, 1987. 8. ITINTEC. Instituto de Investigación Tecnológica Industrial y de Normas Técnicas. Norma Técnica Nacional. Agua Potable - Toma de muestras. ITINTEC 214.005. June, 1987. 9. Lloyd, B. (1982). Water Quality Surveillance. Waterlines, 1, (2), 19-23. 10. Lloyd, B.; Wheeler, D. & Pardón, M. (1984). Safe Water in the Third World. Dept. of Microbiology, University of Surrey, U.K. 11. Lloyd, B.; Pardón, M. & Bartram, J. (1987). The Development & Implementation of a Water Surveillance and Improvement Programme for Peru. American Society of Civil Engineers. International Conference on Resource Mobilisation for Drinking Water Supply & Sanitation in Developing Nations. Puerto Rico. 12. Lloyd, B. & Bartram, J. (1990). Drinking Water Microbiology in Developing Countries. Proceedings of the International Association on Water Pollution Research and Control. International Symposium on Health-Related Water Microbiology. Tubingen, Germany. 13. Lloyd, B. & Helmer, R. (1990). Surveillance of Drinking Water Quality in Rural Areas. WHO/UNEP Published by Longman Scientific & Technical, UK. ISBN 0-582-06330-2. 14. Lloyd, B. & Suyati, S. (1990). A pilot Rural Water Surveillance Project in Indonesia. Waterlines, 7, (3), 10-13. 15. Lloyd, B.; Bartram, J.; Rojas, R.; Pardón, M.; Wheeler, D. & Wedgwood, K. (1991). Surveillance and Improvement of Peruvian Drinking Water Supplies. Robens Institute, DelAgua. A project supported by the UK Overseas Development Administration as part of a technical cooperation programme for the Government of Peru. 16. Ministerio de Salud. Perú. Reglamento de los requisitos oficiales (físicos, químicos y bacteriológicos) que deben reunir las agua de bebida para ser consideradas potables. December, 1946. 17. PAHO (Pan American Health Organization. Organización Panamericana de la Salud - OPS). (1990a). Declaración de Puerto Rico; Abastecimiento de Agua, Saneamiento y Salud. Puerto Rico, 4-6 September.

Bibliography 63

18. PAHO (Pan American Health Organization. Organización Panamericana de la Salud - OPS). (1996). La Calidad del Agua Potable en América Latina. Ponderación de los riesgos microbiológicos contra los riesgos de los subproductos de la desinfección química. 19. PAHO (Pan American Health Organization. Organización Panamericana de la Salud - OPS). (1990b). Conferencia Regional sobre Abastecimiento de Agua y Saneamiento. Evaluación del Decenio Internacional del Abastecimiento de Agua Potable y Saneamiento 1981-1990 y Proyecciones hacia el año 2000. Puerto Rico, 4-6 Setiembre. Volumen 1. 20. Rojas, R. (1994). SANIPLAN. Programa de control de la calidad de agua de consumo humano. Trujillo, Ica y Pisco. 21. Rojas, R. (1993). Quality Control of Lima's Water Supply. University of Surrey, Department of Civil Engineering. 22. Rojas, R. (1992). Quality Control of Piped Urban Water Supplies. 23. Rojas, R. & Bartram, J. (1990). Manual del Supervisor. Vigilancia de los Servicios de Agua de Consumo Humano. Secciones I al VIII. Ministerio de Salud. Lima, Perú. 24. Rojas, R; Vargas, C. (1998) Control y Vigilancia de la Calidad del Agua de Consumo Humano. 25. APHA-AWWA-WPCF Standard Methods For the Examination of Water and Wastewater. 14th Edition, 1975. 26. SEDAPAL. (1992). Lima Water Authority. Anuario Estadístico. 27. Seligmann, R.; Reitler, L. (1965). Enteropathogens in water with low Escherichia coli titer. Journal AWWA 57:1572-1574. 28. Society of Applied Bacteriology Symposium on Microbiological Aspects of Water Management. SAB Summer Conference. Lancaster, 16-20th July 1984. 29. Statutory Instruments, 1989/1147. Water England and Wales. The Water Supply (Water Quality) Regulations 1989. 30. Stenström, T.A. Community Education and Involvement. In Course on Surveillance & Control of Drinking Water Quality. Arusha, Nov. 1990. Centre for Developing Countries. Technical University of Denmark. WHO/DANIDA, 1990. 31. Thames Water Utilities. (1991). Drinking Water Quality, 1990. 32. UN. (1977). Informe de la Conferencia de las Naciones Unidas sobre el Agua. Naciones Unidas. Mar del Plata, 14-25 March. 33. UNEP. (1990). Consultación Mundial sobre Abastecimiento de Agua Potable y el Saneamiento Ambiental para los años de 1990. Declaración de Nueva Delhi, 10-14 September. 34. UNEP/WHO. (1989). Project on Control of Drinking-Water Quality in Rural Areas. Report of a Review Meeting at the WHO Collaborating Centre for the Protection of Drinking-Water Quality and Human Health. Robens Institute. Guildford. 35. Vargas, C. Mejoramiento de la calidad del agua de la ciudad de Lima y el Callao. CEPIS, 1995. 36. Vargas, C. (1995) Control de la calidad del agua de la ciudad del Cuzco. CEPIS. 37. Ward, C. (1990). Groundwater Quality Monitoring in Relation to on-site Sanitation. Waterlines, 8, (4), 11-14. 38. Walsh, J. & Warren, K. (1979). Selective Primary Health Care: An interim strategy for disease control in developing countries. New England. J. Med 301(18), 967.

64 Guidelines for the Surveillance and Control of Drinking Water Quality

39. Wheeler, D. & Bartram, J. (1988). Surveillance Planning. In Course on Surveillance & Control of Drinking Water Quality. Arusha, Nov. 1990. Centre for Developing Countries. Technical University of Denmark. WHO/DANIDA, 1990. 40. Wheeler, D. & Bartram, J. (1990). Sanitary Inspection. In Course on Surveillance & Control of Drinking Water Quality. Arusha, Nov. 1990. Centre for Developing Countries. Technical University of Denmark. WHO/DANIDA, 1990. 41. WHO. (1976). Surveillance of Drinking Water Quality. WHO Monograph Series No 63. WHO, Geneva. 42. WHO. (1978). Conferencia Internacional sobre Atención Primaria de la Salud. Alma Ata 6-12 Setiembre 1978. OMS, Geneva. 43. WHO. (1983). GEMS/WATER Report of the Inter-Regional review meeting on water quality monitoring programmes. Burlington (Ontario) 17-21st October. 44. WHO. (1984). Guidelines for Drinking Water Quality. Vol 1, Recommendations. WHO, Geneva. 45. WHO. (1985). Guidelines for Drinking Water Quality. Vol 3, Drinking Water Quality Control in Small Community Supplies. WHO, Geneva. 46. WHO. (1986). Guiding Principles for National Monitoring of the Water Supply and Sanitation Sector. WHO, Geneva, June, 1986. 47. WHO. (1995). Guías para la calidad del agua potable. Recomendaciones. Segunda edición. WHO, Geneva, 1995. 48. WHO. (1997). Guidelines for drinking-water quality. Surveillance and control of community supplies. WHO, Geneva, 1997. 49. WHO. (1991). Revision of the WHO Guidelines for Drinking-Water Quality. Report of the Review Meeting on Pathogenic Agents and Volume 3 on Surveillance of Community Supplies. Harare, Zimbabwe, 24-28 June, 1991. 50. World Water. (1981). “D-Day for the Water Decade”. Liverpool, p. 3.

ANNEX 1

FREQUENCIES OF SAMPLING AND SANITARY INSPECTION

Frequencies of Sampling and Sanitary Inspection 67

Table 1. Frequencies of Sampling - Urban Systems Physical-Chemical Parameters in the Distribution Network (samples per year)

Sampling frequency Supply areas Parameters Reduced Standard (population supplied) Ground Surface <500 1 2 6 pH 501-5,000 3 6 12 Turbidity 5,001-10,000 4 9 18 Total hardness 10001-24,000 6 12 24 Alkalinity 24,001-50,000 1 /4,000 inhab 1 /2,000 inhab 1 /1,000 inhab

Table 2. Frequencies of Sampling - Urban Systems Bacteriological Parameters in the Consumer Network (samples per year)

Supply areas Sampling frequency Parameters (population served) (standard) <500 6 Total coliforms 500-5,000 12 Thermotolerant coliforms 5,001-10,000 18 E. coli 10,001-24,000 24 24,001-50,000 1 /1,000 inhabitants

Table 3. Frequencies of Sampling - Urban Systems Physical-Chemical A Parameters in the Outlets of the Treatment Plant, Groundwater Sources and Service Reservoirs (samples per year)

Volume of water supplied per Sampling frequency Parameters day or stored Reduced 3 Standard (m ) Ground Surface pH Turbidity Color Odor < 2,000 4 4 4 Taste 2,001-6,000 4 5 6 Nitrate 6,001 – 12,000 4 6 12 Nitrite >12,000 6 12 24 Iron Manganese Aluminum

68 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 4. Frequencies of Sampling - Urban Systems Physical-Chemical B Parameters in the Outlets of the Treatment Plant, Groundwater Sources and Service Reservoirs (samples per year)

Sampling frequency (standard) Parameters Ground Surface Dry residual Chloride Sulphate Calcium Magnesium Sodium Fluoride Total hardness Alkalinity Copper Zinc 3 12 Lead Arsenic Barium Cadmium Cyanide Total chromium Mercury Selenium Phenols

Table 5. Frequencies of Sampling - Urban Systems Bacteriological Parameters in the Outlets of the Treatment Plant, Groundwater Sources and Service Reservoirs (samples per year)

Volume of water supplied Sampling frequency Parameter per day or stored 3 (m ) Reduced Standard <2,000 -- 26 Total coliforms 2,001-6,000 26 52 Thermotolerant coliforms 6,001-12,000 52 104 E. coli >12,000 104 208

Frequencies of Sampling and Sanitary Inspection 69

Table 6. Sampling Frequencies – Rural and Periurban Systems (samples per year)

Number of Sampling frequency Parameter Population supplied samples Standard Treatment plant and sources of One sample Surface water every 2 years groundwater per source Groundwater every 5 years Physical chemical analysis Service reservoirs PH One sample 3 per year Turbidity per component Thermotolerant coliforms Distribution network < 1,000 3 Annual PH 1,001 – 2,000 4 Annual Turbidity 2,001 – 5,000 6 Annual Thermotolerant coliforms

Table 7. Frequency of Sanitary Inspections of the Treatment Plant and System Components (inspections per year)

Volume of water supplied or Sampling frequency Area stored (m3) Reduced Normal <2,000 -- 3 2,001 – 6,000 3 6 Urban 6,001 – 12,000 6 12 >12,000 12 24 Rural ------2

Standard condition. Number of samples that the supplier should normally take from the supply areas.

Reduced condition. Number of samples to be taken when, after a given number of years (usually three), the parameters comply with the values stipulated in the water quality standard.

For supply areas or service reservoirs that supply or store a combination of groundwater and surface water, the Tables corresponding to surface water should be applied.

ANNEX 2

INFORMATION REQUIRED FOR PLANNING A WATER QUALITY CONTROL PROGRAM

Information Required for Planning a Water Quality Control Program 73

I. Information Required for Planning a Water Quality Control Program

1. Input Information

A. Components

Table 1. Input Information. Components

Operat. Volume Depth Pumping Component Name Code Place Status (m3/d) (m) power Source Surface X X X X X Ground Well X X X X X X X Gallery X X X X X Spring X X X X X

Treatment plants X X X X X

Components Storage reservoir X X X X X Distributing Reserv. X X X X X Pump station X X X X X Tank X X X X X Pressure-relief box X X X X X Well X X X X X X X Gallery X X X X X Spring X X X X X

74 Guidelines for the Surveillance and Control of Drinking Water Quality

B. Supply Areas Table 2. Supply Areas

Supply Areas Medium to large suppliers Rural or periurban Region (name) X X District X X Supply area (name) X X Total population X X Population served X X Source Surface X X Ground X X Mixed X X Components Storage reservoir X X Distributing reservoir X X Pump station X X Tank X X Pressure-relief box X X Well X X Gallery X X Spring X X Level of service User connection X X Public faucets X X Tank trucks X X Artesian wells -- X

C. Standards

Table 3. Standards Water Quality (Limits and Exceptions)

Exception Parameter Unit Concentration Legal Dispositive Date Concentration Arsenic mg/L as As 0,005 N/A N/A N/A Lead mg/L as Pb 0,01 N/A N/A N/A Cadmium mg/L as Cd 0,003 N/A N/A N/A - Sulphate mg/L as SO4 200 Directiva 48 11/12/00 250 Chloride mg/L as Cl- 250 ------Nitrate mg/L as NO3 50 ------Iron mg/L as Fe 0,3 ------

Information Required for Planning a Water Quality Control Program 75

D. Sampling Forms

D1 Distribution Network

Table 4. Sampling Forms. Distribution Network

Sample number Supply area Date Time Address Neighborhood Sampling place Continuity Network Hours per day ______Home Days per week ______Sampling point Home School Chlorine residual ______Public office pH ______Shop, store Turbidity ______Food industry

Other industries Type of sample Sampler First Confirmation

D2 Components

Table 5. Sampling Forms. Components

Sample number Code Date Time Sampling point Type of sample Storage reservoir First Distributing reservoir Confirmation Pump station Chlorine residual ______Tank pH ______Pressure-relief box Turbidity Well Gallery Spring Comments: Sampler

76 Guidelines for the Surveillance and Control of Drinking Water Quality

D3 Sources and Treatment Plants

Table 6. Sampling Forms. Sources and Treatment Plants

Sample number Code Date Time Sampling point Type of sample Surface source First Ground source Confirmation Well Chlorine residual ______Gallery pH ______Spring Turbidity ______Treatment plant

Comments: Sampler

E. Forms for Sanitary Inspection

Reservoir Pump station Tank Pressure-relief box Well Gallery Spring

F. Forms for Results of Analyses (laboratory report)

Sample number Results: physical, chemical and microbiological analyses

ANNEX 3

WORKSHOP PARTICIPANTS AND REVIEWERS

Workshop Participants and Reviewers 79

WORKSHOP 1

For Spanish speakers Venue: CEPIS, Lima, Peru Date: September 2-3, 1999

Experts attending:

Beatriz Cáceres Advisor Nelly Nakamatsu SEDAPAL Milagros Cadillo DIGESA Lidia Oblitas Advisor Enrique Calderón Buenos Aires Univ Norma Parra DIGESA Betty Chung SUNASS Ricardo Rojas PAHO/CEPIS María Luisa Esparza PAHO/CEPIS Felipe Solsona PAHO/CEPIS Denise Formaggia S.E. São Paulo Eduardo Stuart DIGESA Fred Hauchman USEPA Carmen Vargas PAHO/CEPIS Teresa Lampoglia PROAGUA/GTZ

WORKSHOP 2

For English speakers Venue: Radisson Hotel, Miami, USA Date: November 18, 1999

Stephanie Adrian USEPA Willie Grabow Pretoria Univ Nicholas Ashbolt UNSW Fred Hauchman USEPA Jaimie Bartram WHO Guy Howard Surrey Univ Xavier Bonnefoy WHO Will Robertson Health Canada Enrique Calderón Buenos Aires Univ Mark Rogers USEPA Keith Christman C.C.C. - USA Felipe Solsona PAHO/CEPIS María Luisa Esparza PAHO/CEPIS Paul Taylor Consultant John Fawell WRC-NSF Terrence Thompson WHO Hend Galal-Gorchev USEPA Peter Toft PAHO/WHO Gerardo Galvis CINARA Yitchak Zohar Israel Min. Health

80 Guidelines for the Surveillance and Control of Drinking Water Quality

Reviewers

María Luisa Esparza PER PAHO/CEPIS-WHO Carmen Vargas PER PAHO/CEPIS-WHO Fred Hauchman USA USEPA Enrique Calderón ARG ETOSS Denise Formaggia BRA S.E. São Paulo María Isabel Meca ARG Advisor Jorge Alvarez ARG DSA - MoH Javier Hernández PER DIGESA - MoH Nelly Nakamatsu PER SEDAPAL María Lucía Martelli BRA FNS - MoH Jaimie Bartram UK WHO Betty Chung PER SUNASS Gerardo Galvis COL CINARA Xavier Bonnefoy DNK WHO Teresa Lampoglia ITA GTZ Barry Lloyd UK Univ. Surrey Pablo Chaparro COL Vig S.P - MoH Ignacio Castillo MEX C.N.A. Beatriz Santamaría MEX Dir. Construc. & Operations GDF Sofía Garrido MEX C.I. de Recursos del Agua Manuel Basterrechea GUT Advisor Eugenio Lammel ARG Aguas Cordobesas

APPENDIX A

NATIONAL PROGRAM FOR THE SURVEILLANCE AND QUALITY CONTROL OF DRINKING WATER

CASE STUDY: “THE COUNTRY”

National Program for the Surveillance and Quality Control of Drinking Water 83

CONTENTS

Page

Appendix A National Program for the Surveillance and Quality Control of Drinking Water. Case Study: “The Country”...... 81

Introduction ...... 87 Chapter I...... 89 1. Rationale and Diagnosis ...... 89 1.1 The Country ...... 89 1.2 Distribution of Communities ...... 89 1.3 Population Growth...... 89 1.4 Situation of the Water Supply and Sanitation Services ...... 91

2. Health of the Population...... 91 2.1 Indicators ...... 91 2.2 Health Care Provided by the Public Health System ...... 91 2.3 Relative Importance of Communicable Diseases ...... 92

3. Preventive Medicine in The Country ...... 95 3.1 Health Programs ...... 95 3.2 Investment...... 95 3.3 Public Health...... 95

4. Prevention of Diseases by Water Supply ...... 98 4.1 Impact of the Water Supply on Disease Reduction ...... 98

5. Surveillance...... 100 5.1 Surveillance of the Water Supply ...... 100 5.2 Surveillance in The Country ...... 101

6. Legal Framework and Organization...... 102

Chapter II ...... 103 7. National Program for the Surveillance and Quality Control of Drinking Water ...... 103 7.1 General...... 103 7.2 Goals of the Surveillance Program ...... 103 7.3 Policies and Strategies ...... 104 7.4 Fields of Action ...... 104 7.5 Scope...... 105 7.6 Hoped-for Results...... 105 7.7 The Program’s Basic Lines of Action...... 108 7.8 Surveillance and Control Programs ...... 112 7.9 Operational Programs ...... 113

84 Guidelines for the Surveillance and Control of Drinking Water Quality

7.10 Support Programs ...... 114 7.11 Options for Implementing Surveillance Nationwide ...... 117

Chapter III ...... 119

9. Origin and Application of Funds ...... 135 9.1 Sources of Funds...... 140 9.2 Use of the Funds ...... 140 9.3 Execution of the Surveillance Program ...... 141 9.4 Stages of Execution of the Program...... 143

List of Tables

Table 1 Total Population of the Country per Urban/Rural Area, Inhabitants, and Communities ...... 89 Table 2 Population Growth in The Country ...... 90 Table 3 Projection of Communities in the Country...... 90 Table 4 Total Population and Coverage of Water Supply and Sanitation Services in the Year 2000...... 91 Table 5 Most Important Communicable Diseases in The Country...... 92 Table 6 Incidence and Relative Importance of the Top Ten Communicable Diseases in Peru (1997-1999)...... 93 Table 7 Communicable Diseases in the Country per State (1999) ...... 94 Table 8 Investment in Disease Control on the Part of the Health and Housing Sectors...... 95 Table 9 Incidence of Communicable Diseases in The Country...... 96 Table 10 Impact of Means of Control on Human Health ...... 98 Table 11 Influence of Water on Human Health...... 98 Table 12 Estimated Reduction of Diseases by the Supply of Good Quality Water (East Africa)...... 99 Table 13 Estimated Reduction of Communicable Diseases by Environmental Control Programs and Others ...... 100 Table 14 Analytical Determinations Stipulated in the Quality Standard...... 107 Table 15 Number of Determinations per Type of Locality ...... 110 Table 16 Analytical Determinations per Level of Surveillance...... 111 Table 17 Frequency of Bacteriological Sampling per Level ...... 111 Table 18 Frequency of Physico-Chemical Sampling per Level ...... 112 Table 19 Frequency of Sanitary Inspectors per Level ...... 112 Table 20 Present Situation of the Programs for the Control of Water...... Quality and Options for Future Interventions...... 117 Table 21 Cost per Sample Taken...... 119 Table 22 Number of Sanitary Inspections to be Effected per Day and per Inspector ...... 120

National Program for the Surveillance and Quality Control of Drinking Water 85

Table 23 Cost of Determinations per Type of Laboratory...... 120 Table 24 Determinations and Cost per Physico-Chemical and Bacteriological Analysis...... 121 Table 25 Cost of determinations per Size of Community and per Year...... 122 Table 26 Cost of Analysis per Year and per Type of Locality ...... 123 Table 27 Cost of Equipping Laboratories...... 125 Table 28 Cost of Staff...... 125 Table 29 Cost of Equipping Laboratories per Level of Intervention...... 126 Table 30 Cost of Vehicles...... 127 Table 31 Projection of the Population to be Served with Water Supply Services...... 128 Table 32 Projection of Communities with Water Supply Services ...... 128 Table 33 Number of Localities, Components per Locality and Total Components. Present Situation (Year 2001). Future Situation (Year 2010) ...... 129 Table 34 Number of Samples to be Obtained for Water Quality Control Present Situation (Year 2001). Future Situation (Year 2010) ...... 130 Table 35 Number of Sanitary Inspections; Present Situation (Year 2001). Future Situation (Year 2010)...... 131 Table 36 Percentage of Participation of Institutions in the Drinking Water Quality Control Activities ...... 132 Table 37 Percentage of Participation of the Surveillance Agency per Line of Action...... 132 Table 38 Total Cost of the Program for the Surveillance and Control of Water Quality (2001 – 2010)...... 133 Table 39 Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001 – 2010 (in US$) ...... 133 Table 40 Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001-2010 (percentage)...... 134 Table 41 Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001 – 2010 – Urban Areas...... 134 Table 42 Cost of Analyses per Year and per Option ...... 135 Table 43 Cost of Sanitary Inspections per Year and per Option ...... 136 Table 44 Cost of Sampling per Year and per Option ...... 137 Table 45 Cost of Implementing Quality Control 2001 – 2010 ...... 138 Table 46 Cost of Quality Surveillance 2001 – 2010...... 139 Table 47 Functions of the Sanitary Authority ...... 142 Table 48 Functions of the Regional Office for the Surveillance of Water Quality ...... 143

National Program for the Surveillance and Quality Control of Drinking Water 87

INTRODUCTION

Before 1991 the countries of Latin America and the Caribbean focused on the quantity rather than the quality of water for human consumption. The outbreak of cholera in Peru that year was a severe blow to that trend and showed up the poor sanitary conditions of water supply services.

At the “International Conference on Water Quality,” sponsored by the Pan American Health Organization and held in Lima, Peru in 1996 at the Pan American Center for Sanitary Engineering and Environmental Sciences, PAHO/CEPIS, one of the recommendations was that the countries of the Region develop programs for the Surveillance and Quality Control of Drinking Water.

A similar request was made to the PAHO by the American heads of state at the Summit Meeting of Santa Cruz de la Sierra in 1996, and to address these needs the Organization drew up a Regional Program for Improving Drinking Water Quality, which contained a diagnosis and a specific proposal of action. The diagnosis clearly recognizes that the situation is not the best with respect to the monitoring and control of drinking water quality.

The Regional Program, together with other regional and local initiatives, is a contribution towards satisfying this demand. Also, the Guidelines for the Surveillance and Control of Drinking Water Quality seek to complement the effort by presenting a methodology that can be applied by governments, agencies, public and private companies, and water consumers in general, to help improve the quality of the water supply services.

In this context, The Country has recognized the need for specific action, and has therefore proceeded to draw up its National Program for the Surveillance and Quality Control of Drinking Water.

National Program for the Surveillance and Quality Control of Drinking Water 89

CHAPTER I 1. Rationale and Diagnosis 1.1 The Country

The Country has an area of 1,500,000 km2 and is divided into 24 States. It borders with Country 1 to the north, Countries 2 and 3 to the south, Country 4 to the east, and the South Sea to the west. The total population in 2000 was approximately 25.7 million inhabitants, of whom 18.2 million (70.8%) were living in urban areas and 7.5 million (29.2%) in rural areas. 1.2 Distribution of Communities

The number of communities in The Country in 2000 was 65,000, classified as follows: 44,700 remote; 19,300 rural, and 500 urban. For classification purposes, communities of 2,500 inhabitants and over are considered urban communities; from 100 to 2,499 inhabitants are rural communities; while remote communities have up to 100 inhabitants only. Table 1 shows the population breakdown for The Country. 1.3 Population Growth

Based on the population projection published by the National Statistics Institute (NSI), which reveals a sustained growth rate of 2.4% over the past few years, it is estimated that by 2010 The Country will have a population of 32.6 million inhabitants. See Tables 2 and 3 for projections of the country's demographic growth and number of communities between the years 2000 and 2010.

Table 1. Total Population of The Country per Urban/Rural Area, Inhabitants, and Communities

Population Communities Number Type Total Urban Rural Under 50 34,952 650,614 0 650,614 Remote 50 - 99 9,780 780,594 0 780,594 100 - 199 9,251 1,469,927 0 1,469,927 200 – 499 7,979 2,735,77 0 2,735,677 Rural 500 – 999 1,955 1,476,257 0 1,476,257 1,000 – 2,499 593 899,233 282,750 616,483 2,500 – 4,999 251 843,348 777,323 66,026 5,000 – 9,999 93 732,111 722,865 9,246 10,000 – 19,999 42 636,231 636,231 0 20,000 – 49,999 45 1,632,511 1,632,511 0 Urban 50,000 – 99,999 27 2,129,860 2,129,860 0 100,000 – 199,999 16 2,697,648 2,697,648 0 200,000 – 499,000 10 2,704,000 2,704,000 0 over 500,000 6 6,311,989 6,311,989 0 Total 65,000 25,700,000 17,895,176 7,804,824

90 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 2. Population Growth in The Country (in thousands)

Inhabitants Year Total Urban Rural 2000 25,700 17,895 7,805 2001 26,319 18,405 7,908 2002 26,952 18,929 8,013 2003 27,601 19,469 8,119 2004 28,265 20,023 8,226 2005 28,945 20,594 8,335 2006 29,642 21,181 8,445 2007 30,355 21,784 8,556 2008 31,086 22,405 8,669 2009 31,834 23,043 8,784 2010 32,600 23,700 8,900

Table 3. Projection of Communities in The Country

Year Communities 2000 2002 2004 2006 2008 2010 Under 50 34,952 34,962 34,971 34,981 34,990 35,000 50 - 99 9,780 9,824 9,867 9,911 9,956 10,000 100 - 199 9,251 9,300 9,350 9,400 9,450 9,500 200 – 499 7,979 7,983 7,987 7,991 7,995 7,999 500 – 999 1,955 1,964 1,973 1,982 1,991 2,000 1,000 – 2,499 593 594 596 597 599 600 2,500 – 4,999 251 253 255 257 259 261 5,000 – 9,999 93 102 113 124 136 150 10,000 – 19,999 42 50 59 69 82 97 20,000 – 49,999 45 49 54 59 65 71 50,000 – 99,999 27 30 33 37 41 45 100,000 – 199,999 16 17 19 21 23 25 200,000 – 499,000 10 11 12 13 15 16 over 500,000 6 7 7 8 9 10 Total 65,000 65,154 65,309 65,463 65,618 65,774

National Program for the Surveillance and Quality Control of Drinking Water 91

1.4 Situation of the Water Supply and Sanitation Services

By mid-2000, the activities of the different institutions involved in water supply and sanitation had resulted in a coverage of only half of the total population of The Country. Table 4 shows the extent of the coverage in urban and rural areas.

Table 4. Total Population and Coverage of Water Supply and Sanitation Services in the Year 2000

Population Country Urban Rural served N.° % N.° % N.° % Water supply 12,724,000 49.5 10,862,000 60.7 1,862,000 23.9 Connections 10,112,000 39.3 8,944,000 50.0 1,168,000 15.0 Easy access 2,612,000 10.2 1,918,000 10.7 694,000 8.9 Sanitation 10,670,000 41.5 9,627,000 53.8 1,043,000 13.4 Connections 8,755,000 34.1 7,912,000 44.2 843.000 10.8 Easy access 1,915,000 7.5 1,715,000 9.6 200,000 2.6

Total population 25,700,000 100.0 17,895,000 69.6 7,805,000 30.4

2. Health of the Population

2.1 Indicators

The most sensitive indicator of the population's well-being is the morbidity rate because it provides information about diseases which do not necessarily cause death but which reduce a person's capacity for normal work or school activities and stimulate the demand for health services. Also, unlike the mortality rate, it takes into account the accumulative weakening effect of recurrent diseases.

2.2 Health Care Provided by the Public Health System

In 1999, the health authorities reported a total of 1,052,718 cases of communicable diseases for a set of 51 pathologies submitted to epidemiological recording and monitoring. Roughly half of the cases (48.4%) correspond to under-five-year-olds and two thirds to under- 15s.

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2.3 Relative Importance of Communicable Diseases

Table 5 lists the six most important diseases in the country, grouped per natural region and infant mortality rate.

Tables 6 and 7 show the incidence and relative importance of the top ten causes of communicable diseases from 1997 to 1999 and the most significant communicable diseases notified by health professionals at the state level in 1998.

From an analysis of the information in Table 6, it can be deduced that the common cold and other acute respiratory infections in 1999 accounted for almost half of the cases (46.1%), followed by gastroenteritis, enteritis and dysentery (24.3% of the cases, showing an upward trend over the past few years). These are followed by helminthiasis (6.5%), malaria (4.5%), respiratory tuberculosis (3.0%), diseases that are preventable with vaccines (measles, whooping cough, tetanus, acute poliomyelitis, and diphtheria) with 5.1%, and typhoid and paratyphoid with 2.0%.

Table 5. Most Important Communicable Diseases in The Country

Region (per 1000 live births Order of most important communicable and less than diseases (1999) one year old) 1 2 3 4 5 6 Metropolitan Acute Gastroenteritis Tuberculosis Helminthiasis Measles Chicken pox 55-56 respiratory and dysentery North Gastroenteritis Acute Tuberculosis Measles Typhoid Mumps 80-83 and dysentery respiratory South Gastroenteritis Acute Typhoid Mumps Helminthiasis Tuberculosis 92-96 and dysentery respiratory Central Acute Gastroenteritis Mumps Helminthiasis Tuberculosis Typhoid 103-115 respiratory and dysentery Coastal Acute Gastroenteritis Typhoid Helminthiasis Tuberculosis Mumps 66-73 respiratory and dysentery Jungle Gastroenteritis Acute Helminthiasis Tuberculosis Typhoid Measles 124-142 and dysentery respiratory Highlands Acute Gastroenteritis Typhoid Mumps Helminthiasis Tuberculosis 120-135 respiratory and dysentery Country Acute Gastroenteritis Tuberculosis Typhoid Helminthiasis Measles respiratory and dysentery

Table 6. Incidence and Relative Importance of the Top Ten Communicable Diseases in Peru (1997-1999)

1997 1998 1999

Diseases Reported by Reported by Rate per R per Rate per Reported by Number % Order professional NUMBER % Order professional Number % Order 100,000 100,000 100,000 professional% % % Common cold and other acute 243,133 40.4 1 1,334.0 86.2 299,225 42.4 1 1,599.5 97.7 347,122 46.1 1 1808.2 80.1 respiratory infections Gastroenteritis and dysenteries 152,536 25.3 2 836.9 75.7 203,263 28.8 2 1,086.6 78.8 182,940 24.3 2 953.0 79.9

Helminthiasis 49,518 8.2 3 271.7 82.1 43,628 6.2 3 233.2 85.0 48,653 6.5 3 253.4 84.3

Malaria 20,483 3.4 6 122.4 100.0 28,563 4.1 4 152.7 100.0 33,724 4.5 4 175.7 100.0

Tuberculosis 21,579 3.6 5 118.4 89.7 22,753 3.2 5 121.6 91.8 22,792 3.0 5 118.7 94.7

Typhoid and paratyphoid 23,868 4.0 4 131.0 90.6 21,011 3.0 6 112.3 88.7 15,358 2.0 6 80.0 91.0

Chicken pox 5,421 0.9 29.7 84.7 6,972 1.0 37.3 88.2 13,266 1.8 7 69.1 93.5

Measles 12,708 2.1 8 69.7 84.8 7,619 1.1 10 40.7 79.4 13,099 1.7 8 68.2 89.0

Scabies 9,721 1.6 9 53.3 60.9 10,030 1.4 8 53.6 57.3 12,149 1.6 9 63.3 65.6

Influenza 15,642 2.6 7 85.8 61.4 12,727 1.8 7 68.0 51.1 11,959 1.6 10 62.3 54.8

Whooping cough 8,238 1.4 10 45.2 64.4 7,164 1.0 38.3 63.0 ------

Other salmonella infections ------8,810 1.2 9 47.1 86.0 ------

Other communicable diseases 39,388 6.5 11 – 51 ------

All diseases 602,235 704,914 752,718

Table 7. Communicable Diseases in the Country per State (1999)

Order of communicable diseases Gastro- Acute Respiratory Typhoid Whoo Tubercu- enteritis Helmin- Blenno- Chicken Viral State respiratory tubercu- and para- Measles Mumps ping Malaria Influenza losis other and thiasis rrhagia pox Hepatitis infections losis typhoid cough forms dysentery State A 1 2 3 7 5 6 8 9 4 10 ------State B 1 2 4 7 5 3 8 6 9 10 ------State C 1 2 4 6 7 3 8 9 5 - - 10 ------State D 10 3 1 2 9 - - 4 7 5 6 ------State E 1 2 4 7 - - 8 9 - - 5 10 6 3 - - - - State F 6 1 2 4 5 - - 3 - - 9 10 8 - - - - 7 State G 1 2 7 5 - - 4 8 9 6 10 - - - - 3 - - State H 1 2 - - 5 10 4 7 6 9 8 - - 3 - - - - State I 1 2 7 6 - - 5 4 - - - - 9 8 3 10 - - State J 3 2 6 7 - - 1 - - - - 8 - - 10 4 5 - - State K 1 2 4 6 7 3 - - 10 8 - - - - 5 9 - - State L 2 4 5 8 - - 3 - - 9 7 10 - - 1 6 - - State M 1 3 6 5 10 4 ------9 8 2 7 - - State N 1 3 6 5 10 2 8 7 - - 9 - - 4 - - - - State O 1 2 3 4 7 6 9 - - 5 10 - - 8 7 - - State P 2 4 6 5 - - 3 - - 10 8 7 9 1 - - - - State Q 1 3 4 10 - - 2 - - 8 6 9 7 4 - - - - State R 1 2 5 5 8 3 - - 10 7 9 6 ------State S 1 3 7 8 9 4 - - - - 6 - - 10 2 5 - - State T 1 2 6 5 7 4 - - - - 10 8 9 - - 3 - - State U 1 2 6 5 10 4 7 - - 9 8 - - - - 3 - - State V 1 2 3 5 6 4 - - 9 8 7 - - - - 10 State W 1 2 7 5 4 6 10 - - - - 8 9 3 - - - - State X 1 2 6 4 10 3 - - - - 8 7 - - 5 9 - - State Y 1 2 3 4 5 7 - - 9 8 10 6 ------Total country 1 2 5 6 8 3 9 13 7 11 12 4 10 - -

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3. Preventive Medicine in The Country

3.1 Health Programs

The goals and policies designed and applied in the health sector in recent years have aimed principally at extending the health care system, in particular to cover maternal-child care, preventive health programs, health development in peri-urban and rural areas, and the prevention and control of communicable diseases.

3.2 Investment

Investments made by organizations dedicated to health services (Social Security Institute, Ministry of Health, and the non-public sub-sector) can be grouped as follows:

• Curative medicine (treatment) = Direct health care • Preventive medicine (individual) = Vaccination, Maternal-Child and Nutrition Programs • Preventive medicine (mass/public health) = Basic sanitation

The expenditure of the various organizations is shown in Table 8, where it can be seen that approximately 97% of the total expenditure is on health care using curative medicine, that is, medical treatment.

Table 8. Investment in Disease Control on the Part of the Health and Housing Sectors (percentages)

Ministry of Ministry of Action Social security Private Total health housing Health care 93.9 ------55.5 Vaccination 7.7 ------1.7 Treatment 85.2 100.0 100.0 --- 53.8 Control of communicable 3.9 ------1.1 diseases Environmental health 2.2 ------100.0 43.4

3.3 Public Health

All communicable diseases can be prevented, some more easily than others. The principle of public health action involves setting up barriers at selected points of the cycle of communication of the disease. The means of control employed are usually those of direct health care, vaccination, and environmental control. Environmental control is often the most economic and rational method, and for certain groups of diseases it is sometimes the only feasible method of prevention. Table 9 shows the main means of controlling the principle communicable diseases.

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All of these public health programs contribute in one way or another to improving the quality of life of the inhabitants of a country, and the water supply and sanitation programs are at the same time the most significant and those which call for the greatest amount of funding for their implementation, but not for their operation. However, for the greatest possible impact, the water supply and sanitation programs should go hand-in-hand with hygiene education programs.

The main fields identified as having direct impact on the environment because of their contribution to the setting up of barriers against communicable diseases are:

• Water supply • Sanitation • Food control • Collection and disposal of solid waste • Control of public establishments • Control of vectors • Hygiene in the home • Occupational health • Air pollution

Once the communicable diseases affecting The Country have been grouped according to the means of control indicated in Table 9, it is then possible to prepare Table 10. Table 10 indicates the impact of the different types of intervention on the control of communicable diseases. Environmental control is found to produce the greatest benefit, providing that it is linked with other programs, mainly hygiene education. Moreover, if we compare investments made by the different institutions in the fight against communicable diseases with the effectiveness of the programs for the control of communicable diseases, it becomes evident that preventive action, especially environment-related, is a highly effective tool for reducing pressure at the curative or treatment level.

Table 9. Incidence of Communicable Diseases in The Country (1999)

Rates per Type of control (*) Diseases Total cases % Order 100,000 V T En H. Ed Other acute respiratory infections 222,301 29.5 01 1,157.9 x x Gastroenteritis and other diarrheal 174,698 23.2 02 910.0 x diseases Common cold 124,821 16.6 03 650.2 x x Other helminthiases 47,431 6.3 04 247.1 x Malaria 33,724 4.5 05 175.5 x Respiratory tuberculosis 21,038 2.8 06 109.6 x Typhoid and paratyphoid 15,358 2.0 07 80.0 x Chicken pox 13,266 1.8 08 69.1 x Measles 13,039 1.7 09 67.9x Scabies 12,149 1.6 10 63.3 x Influenza 11,659 1.6 11 62.3x x x

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Rates per Type of control (*) Diseases Total cases % Order 100,000 V T En H. Ed Mumps 7,844 1.0 12 40.9x Whooping cough 7,145 0.95 13 37.2 x Other salmonella infections 6,845 0.91 14 35.7 x Viral hepatitis 6,711 0.89 15 35.0 x Food poisoning 5,680 0.75 16 29.6 x Shigellosis 5,636 0.75 17 29.4 x Blennorrhagia 5,285 0.70 18 27.5 x x Amebiasis 2,610 0.35 19 13.6 x Leishmaniasis 2,410 0.36 20 12.6 x Tuberculosis and other forms 1,754 0.23 21 9.1 x Yellow fever 1,363 0.18 22 7.1 x x Ancylostomiasis and Necatoriasis 1,222 0.16 23 6.4 x (hookworms) Streptococcal angina 1,157 0.15 24 6.0 x Late syphilis 1,099 0.15 25 5.7 x x Early syphilis 1,091 0.15 26 5.7 x x Brucellosis 925 0.12 27 4.8 x Lymphogranuloma venereum 650 0.09 28 3.4 x x White chancre 571 0.08 29 2.3 x x Bubonic plague 454 0.06 30 2.4 x Tetanus 404 0.05 31 2.1x Rubella 355 0.05 32 1.8x Anthrax 384 0.05 33 1.8x x x Barthonelitis 194 0.03 34 1.0 x x Meningococcal infections 193 0.03 35 1.0 x x Echinococcosis (hydatid disease) 189 0.03 36 1.0 x x Viral encephalitis 165 0.02 37 0.9 x x x Acute poliomyelitis 129 0.02 38 0.7 x Diphtheria 127 0.02 39 0.7x Leprosy 87 0.01 40 0.5 x x Toxoplasmosis 62 0.01 41 0.3 x x Pinta 48 0.01 42 0.3 x Congenital syphilis 37 0.005 43 0.2 x Human rabies 27 0.004 45 0.1 x Trachoma 25 0.003 46 0.1 x Exanthematic typhus 25 0.003 47 0.1 x x Yaws 21 0.003 48 0.1 x x Chagas disease 12 0.002 49 0.1 x x Cholera x x Smallpox x Total 752,718 100 3,920.8 ** V = Vaccination T = Treatment En = Environmental control H. Ed = Hygiene education.

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Table 10. Impact of Means of Control on Human Health

Complementary control measures (2) Percentage of Equivalent Means of Investment cases Vaccination Total investment control Hygiene % controlled (1) Vaccination Treatment and hygiene per person Education education

Vaccination 64,999 ------64,999 1.7 26.2

Treatment 1,157 -- -- 9,062 -- 10,219 53.8 5,265.0 Environmen- 315,553 1584 21 347,864 12,508 677,530 44.5 (3) 59.12 tal control TOTAL 381,708 1584 21 356,926 12,508 752,748 100.0

(1) Controlled by the indicated means of control. (2) Controlled in conjunction with actions on the environment. (3) Including control of communicable diseases.

4. Prevention of Diseases by Water Supply

4.1 Impact of the Water Supply on Disease Reduction

The advantage of drinking water supply systems goes far beyond the mere convenience of the supply. Some kind of improvement in the health of populations benefited with safe water supplies is always predictable. The mechanisms whereby water influences human health are complicated. The Ross Institute (School of Hygiene and Tropical Medicine of the University of London) has developed a classification system whereby the mechanism of influence replaces the responsible agent as the principal classifying factor. Table 11 summarizes this classification.

Table 11. Influence of Water on Human Health

Mechanism of influence Examples Measures of control

I Waterborne (fecal oral) a) Classic Typhoid, cholera, etc Improvement of the microbiological b) Non-classic Infectious hepatitis, etc. quality of the water II. Hygiene-related a) Skin and eyes Scabies, trachoma, etc Improvement in the quantity and the b) Diarrheas Bacillary dysentery, etc continuity III Water-based a) Penetration Bilharziasis, etc Protection of consumers b) Ingestion Dracontiasis, etc Protection of water source IV Infection through vectors a) Bites Trypanosomiasis, etc Channeling the water from the source b) Reproduction in the water Yellow fever, etc to the point of consumption

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From the above, it is clear that the consumption of water free from fecal waste, besides contributing to the protection of the consumers, also plays a key role in the control of a wide range of hygiene-related diseases. Its contribution to health is made in several ways, for example, the quality of the water has a fundamental influence on classic water-related diseases such as diarrhea, bacillary and amebic dysentery, typhoid, paratyphoid and hepatitis.

In addition, other diseases are influenced by the continuity and quantity of the safe water supply rather than by the ingestion of the microbes that may be present in the water (quality). Such diseases are associated with habits of hygiene and personal cleanliness, and the water contributes directly to their prevention (hygienic handling of food, clean hands, etc).

It is difficult to distinguish the contributions to health improvement made by the different parameters used in water quality assessment, and even more difficult to predict the health impact of a specific activity. Studies have estimated that good quality drinking water contributes to a substantial reduction of many diseases. In studies carried out in Africa, this degree of reduction has been estimated as shown in Table 12.

Table 12. Estimated Reduction of Diseases by the Supply of Good Quality Water (East Africa)

Disease Percentage (%) of reduction of disease Guinea worm 100 Typhoid 80 Schistosomiasis 80 Leptospirosis 80 Gambian trypanosomiasis 80 Scabies 80 Bejel 70 Eye inflammations 70 Non-specific schistosomiasis 60 Bacillary dysentery 50 Amebiasis 50 Non-specific dysentery 50 Gastroenteritis (from 4 weeks – 2 years) 50 Gastroenteritis (over 2 years) 50 Skin and subcutaneous infections 50 Diarrhea in newborn babies 50 Paratyphoid and other Salmonelloses 40 Intestinal schistosomiasis 40 Ascariasis 40 Otitis externa 40 Average 52

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Table 13 analyzes the impact on communicable diseases of the different measures of control applied in The Country, and it shows that the theoretical impact of environmental control is highly significant. In this reference, it must be understood that the effectiveness of environmental control programs results from multidisciplinary efforts in the technical field as well as in the social and educational areas.

Table 13. Estimated Reduction of Communicable Diseases by Environmental Control Programs and Others

Water Sanitation Hygiene Food Cases 1984 Gray Disposal of Quality Quantity education hygiene waters excreta 01. Gastroenteritis and other Xx xxx Xxx 0 xx xx 174,698 diarrheal infections 02. Other helminthiases X xx xx x xxx xx 47,431 03. Malaria 0 0 0 x 0 0 33,724 04. Typhoid and paratyphoid Xx xx xx x xx xx 15.358 05. Scabies 0 xxx xxx 0 0 0 12,149 06. Other salmonella infections X xx xx x xx xxx 6,845 07. Viral hepatitis X xx xxx 0 xx xx 6.711 08. Food poisoning 0 x xx 0 xx xxx 5,680 09. Shigellosis Xxx xxx xxx 0 xx xx 5,636 10. Amebiasis X xxx xxx 0 xx xx 2,610 11. Leishmaniasis 0 0 xx xx 0 0 2,410 12. Yellow fever 0 0 xx xx 0 0 1,363 13. Ancylostomiasis and Necatoriasis X x x x xxx xx 1,222 (Hookworms) 14. Acute poliomyelitis X xxx xxx 0 xx xx 129 15. Trachoma 0 xxx xxx 0 0 0 25 16. Exanthematic typhus 0 xx xx 0 0 0 25 TOTAL 316,016 Percentage 42% Total number of cases reported in 1986 752,718 xxx : Very significant xx : Significant x : Of little significance 0 : Not significant

5. Surveillance

5.1 Surveillance of the Water Supply

The surveillance of drinking water is an activity distinct from quality control but both compatible with it and complementary to it. Surveillance is a task of investigation, with emphasis on public health, and the institution responsible for it is the Ministry of Health, as stipulated in the Health Code.

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Quality control is a routine monitoring activity performed to guarantee that the quality of the water and of the supply service throughout the distribution system up to its delivery in the communities complies with regulations and standards currently in force. The supplier is responsible for quality control.

(PAHO/WHO), in the Guidelines for drinking water quality, vol. III, makes a clear distinction between the two activities, as follows:

The organizational structures designed to guarantee compliance with the demands of the laws, standards or codes of practice referring to the quality of the drinking water should be such as to facilitate the sharing of the surveillance process between the water supply company and a separate surveillance agency, preferably independent. The former shall be responsible at all times for the quality and safety of the water it produces.

The tests and routine monitoring carried out by the water supply company shall be referred to as water quality control tests; not to be confused with the verifications performed independently by the surveillance agency. Both the water quality control tests and the tests performed by the surveillance agency shall be applied to all the types of water available in the community.

The surveillance agency shall preferably be constituted at the national level, and shall operate at the central, provincial (regional) and local levels, usually through the health authorities. This surveillance agency shall deal with the aspects of public health associated with drinking water supplies and shall have the general responsibility of guaranteeing that all the systems under its jurisdiction are free from any health hazard.

5.2 Surveillance in The Country

Surveillance in The Country was applied only in the capital city. It began in the late 1940s as an activity of the Ministry of Health because of the absence of water quality control in the distribution network on the part of the suppliers. The surveillance program continued in the 50s, was gradually reduced in the 60s, and practically disappeared in the 70s, when the big suppliers began to apply their own very basic quality control programs. The disappearance of the program is attributed to the negligible impact of surveillance activities, since political interference in the management of the water supply systems meant that the Ministry of Health's surveillance unit was prevented from questioning the work of the water supplier, and this led to progressive budget reductions and the loss of the professionals who were responsible for the surveillance work.

The position today is that, in the framework of the Regional Program for the Improvement of the Quality of Drinking Water, subscribed to by The Country, the health authorities have agreed with the representatives of the water suppliers and of the regulatory agency to draw up an overall program setting forth the responsibilities of each of the parties and

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the channels of coordination. This will ensure a sound quality control program for both urban and rural areas, and the information produced by the water supply services will be used by the surveillance agency in its evaluation of the risk to human health posed by the drinking water.

6. Legal Framework and Organization

The Sanitary Code of the Ministry of Health stipulates that this Ministry is responsible for the surveillance of drinking water quality. The Ministry has entrusted this task to its Environmental Health Office. In the organizational structure, the Environmental Health Office has a Water Quality Department which is responsible for planning surveillance activities nationwide at the urban and rural levels.

In discharging its surveillance responsibility, the Ministry of Health has promulgated the Standard on the Quality of Drinking Water, which is applicable throughout the country in urban and rural areas. One of the features of the Quality Standard is that it defines two categories of analytical determinations, one obligatory group and one optional, depending on the capacity of the water supply facilities.

The water supply sector, for its part, has a regulatory agency responsible for supervising the water supply agency. This regulatory agency issues directives stipulating the measures to be taken by the suppliers to determine the quality of the water and of the service they are providing.

The suppliers themselves are organized in an association which enables them to negotiate with the regulatory agency so that, for example, any requirements they may be asked to comply with can be implemented gradually and within an agreed timeframe, which will usually be relatively short (within a three-year period).

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CHAPTER II

7. National Program for the Surveillance and Quality Control of Drinking Water

7.1 General

This Surveillance Program for drinking water systems has been designed to cover the systems managed by water service agencies which normally operate in urban areas, as well as municipal systems and those managed by rural communities.

At the same time it was decided that the Program for the Surveillance of Drinking Water Quality should include not only the quality of the water itself, but also the quality of the service provided. This information will be valuable in determining the investment needed for the rehabilitation, extension or improvement of the sanitary infrastructure. With reference to the quality of the supply service, this is evaluated using the following indicators: water quality, continuity, coverage, quantity, and cost.

It was also determined that the surveillance and control program would cover the whole water distribution system, from the quality of the treatment plant to the start of the home connection.

In the present case, the surveillance program will determine whether the quality and the health risk fall within the recommendations and standards currently in force, and it will then communicate its findings to the companies or institutions responsible for managing the water supply services, and oblige these to comply with the recommendations and standards.

7.2 Goals of the Surveillance Program

To contribute to an improvement in the health and quality of life of the population with reference to the use of collective water supply systems, by identifying the actions required to improve the quality of the water services.

7.2.1 Specific Objectives

a) To evaluate the physical, chemical and bacteriological quality of the water for human consumption.

b) To determine the risk to human health posed by water supply systems.

c) To quantify regional and national coverage.

d) To determine the degree of continuity of the supply services.

e) To determine the cost of the drinking water.

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f) To contribute to programs for the rehabilitation and extension of water supply systems, identifying priority areas for investment, and issuing reports on the basic service characteristics to keep national and regional institutions informed as to where the most serious problems are found.

g) To disseminate at the technical and political levels the results of the Surveillance Program.

h) To identify the hygiene education programs that are required to improve the habits of hygiene of the beneficiary population.

i) To raise people's awareness of the need to demand of the water suppliers reasonably- priced good-quality water in an adequate quantity 24 hours a day.

j) To strengthen the epidemiological surveillance system in order to assess the impact of the Surveillance Program and of the steps taken to improve water quality.

k) To improve the laws, regulations, and standards linked with the conservation and preservation of drinking water quality.

7.3 Policies and Strategies Considering that the surveillance and control of water quality are not highly developed activities in The Country because of the difficult social and economic situation it is going through, the Program proposes that rational policies be applied in designing solutions and that maximum use be made of existing resources, taking into account the real needs of the people and the availability of the resources.

The obtaining of the results should establish a series of strategies in service improvement, coordination and development of the sectors involved, training of human resources, promotion of the participation of the communities, investment economy, and adequate financing.

7.4 Fields of Action The Surveillance Program defines two fields of action: a) the water supply system, and b) the quality of the services. The supply system is the physical part of the distribution network including its components, while the quality of the services is represented by aspects of quality, quantity, continuity, coverage, and cost.

Supply system Exposed to the least possible risk of contaminating or being contaminated (Physical infrastructure) Observation of the quality of the water in all the components of the supply system Quality of service Quality Fit for human consumption Quantity Sufficient for domestic purposes Coverage Covering the greatest possible number of inhabitants Continuity Available most of the year Cost The minimum necessary

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7.5 Scope

In principle, the Program has been drawn up for a ten-year horizon and it includes all collective drinking water supplies delivered by means of home connections, public standpipes, or water tank trucks. In urban areas it covers the whole of the inhabitable area, while in rural areas it covers only those parts served by water supply networks. Thus, for the purposes of drawing up this Program, all communities of more than 100 inhabitants were taken into account.

There are two auxiliary activities that are not regarded as part of the Surveillance Program:

• Authorization for the use of new sources of water for supply purposes; and • Follow-up of raw water quality at the supply sources.

Authorization for the use of new sources of water for supply purposes is required only during an initial planning stage, and approval is normally given by the health authorities. This is not included among the responsibilities of the surveillance agency.

With regard to the quality control of raw waters at supply sources, specifically of surface waters, those responsible for exploiting them are obliged to keep the competent authorities informed of their quality so that a historic follow-up can be made of their behavior. In this case the competent authorities are the watershed authorities, but it is obligatory that the information be communicated to the health authorities for follow-up.

The fields of surveillance and control of water quality deal with the surveillance and control of:

A. Piped water (components, home connections, and public standpipes)

a) Disinfected water b) Non-disinfected water

B. Water not distributed through pipes (wells, tank trucks, etc.)

a) Disinfected water b) Non-disinfected water

7.6 Hoped-for Results

7.6.1 Impact on the Country's Social Progress and Development

Water is essential for the existence of the human being, and its use improves the quality of life. Water plays an important role in personal hygiene and cleanliness, and thus becomes a fundamental component in attending to the basic needs of the population.

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The end goal of the surveillance of water quality is to contribute to improving the general level of health and well-being of the community, and hence to contribute to the social and economic progress of the country.

7.6.2 Impact on Disease Reduction and Control

In The Country there exists a high rate of mortality caused by gastrointestinal diseases and others, linked with the lack of drinking water and/or its low quality.

A combination of a good water supply and education on the subjects of personal hygiene and the proper use of water will reduce the risk of transmission of water-related diseases, and contribute to an increase in life expectancy.

7.6.3 Surveillance and Control Activities

In The Country, water-related diseases and those of fecal-oral transmission are the most significant. In 1999, diarrheal diseases alone accounted for 24.3% of cases of medical treatment of notifiable diseases. (See Table 6)

Thus the surveillance activities will focus mainly on determining water quality, service quality, and level of sanitary risk.

The task of determining water quality mainly involves detecting the presence of biological agents. However, since chemicals also pose certain health risks, they will be included in the water quality assessment.

The quality of the service will be defined by the basic indicators of quality, quantity, continuity, coverage, and cost.

Sanitary Inspection activities will be directed to determining the susceptibility of the system to accidental contamination or contamination induced by external agents.

It is therefore planned to carry out the surveillance and control activities in three basic areas a) the distribution system itself, from the outlet of the storage structures to the home connection; b) water storage structures such as cisterns and distribution reservoirs; and c) outlets from treatment plants or supply sources, which could be feeder mains or storage reservoirs.

7.6.4 Distribution System

In this part of the water supply system the bacteriological quality will be evaluated, as well as a small group of physical-chemical parameters, and this assessment will be complemented with the sanitary inspection of the components that make up the distribution system. In view of the types of supply existing in The Country, two situations are considered:

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a) Disinfected water

In systems where the water is disinfected, the analytical determinations to be carried out obligatorily are chlorine residual, turbidity, and pH. The determination of fecal coliforms may be effected less frequently than is recommended in the standard.

b) Non-disinfected water

In supply systems where the water is not disinfected, the determination of thermotolerant coliforms will be obligatory, as will that of turbidity. Bearing in mind the rapid variation in the microbiological quality of the water, these systems will require a high frequency of sampling. Sanitary inspections will also need to be more frequent than in (a).

7.6.5 Reservoirs and Outlets of Treatment Plants

In the feeder mains (the stretch leading directly from the treatment plant or supply source to the storage reservoir or distribution reservoir), in addition to the determinations of chlorine residual and thermotolerant coliforms, special emphasis will be placed on the physical-chemical determinations of an aesthetic nature that affect the acceptability of the water, as well as testing for inorganic and organic elements that affect human health. Table 14 shows the determinations of physical-chemical compounds established in the drinking water quality standard taken into account in planning the surveillance and control program. It also shows the chlorine residual and thermotolerant coliform determinations.

Table 14. Analytical Determinations Stipulated in the Quality Standard

Determinations and Affecting Inorganic Compounds Organic Compounds Acceptability pH Arsenic Chlorinated alkanes Turbidity Cadmium Chlorinated ethenes Color Chromium Aromatic hydrocarbons Hardness Cyanide Polynuclears Chloride Fluoride Chlorobenzenes Total solids Mercury Pesticides Sulphate Nitrate Phenols and chlorophenols Aluminum Lead Trihalometanes Copper Selenium Benzene and lower alkylbenzenes Iron Manganese Zinc Sodium

108 Guidelines for the Surveillance and Control of Drinking Water Quality

Since the presence in drinking water of the inorganic and organic parameters shown in the above table is very infrequent, it is planned to test for them only in the feeder mains and sporadically in the reservoirs. However, depending on the capacity of the testing laboratories, such tests may also be performed in the distribution network. In the event that the quality of the raw water indicates the presence of substances that may affect health or alter the organoleptic quality, or if the water has been treated with unauthorized organic or inorganic chemicals, those responsible for water quality control should measure the affected component frequently.

7.7 The Program's Basic Lines of Action

7.7.1 Surveillance and Control Levels

The surveillance and control program is not only aimed at discovering what is wrong in order to correct the situation, but it also seeks to demand and/or identify the remedial measures that the institutions responsible for the management of the systems need to apply in order to reduce or remove the sanitary risks.

To make the Program for the Surveillance and Control of Drinking Water Services viable, it is planned to implement it in stages. Taking into account the analytical capacity of the laboratories available in the water service companies and in the public health system, the program will be implemented level by level, applying the highest levels of execution to the cities with the largest population that have well-equipped laboratories and the lowest levels to small communities that do not have laboratories.

The surveillance agency and the regulatory agency will bring pressure to bear on those responsible for drinking water quality control so that the number of analytical determinations will gradually increase from year to year.

The basic criteria for setting the surveillance levels were defined based on the availability of human, material, and financial resources. To this effect five levels of surveillance and control have been established, ranging from minimal indispensable actions to the ideal or recommended level.

7.7.2 Recommended Evaluations and Sampling Frequency

To achieve an ideal level of quality control, in the framework of the water quality standard, consensus was reached by the health authorities, the regulatory agency and the representative of the suppliers in the selection of analytical parameters. The analyses to be made and the sampling frequencies have been grouped according to the population size of the localities, which were defined in five categories: a) large cities with populations of over 200,000 inhabitants; b) medium cities with 50,000 to 200,000 inhabitants; c) small cities with 10,000 to 50,000 inhabitants; d) towns with 2,500 to 10,000 inhabitants; and e) rural communities with populations of 100 to 2,500 inhabitants. In addition, the different parts of the water supply system were distinguished: a) outlet from the treatment plants; b) water storage reservoirs, and

National Program for the Surveillance and Quality Control of Drinking Water 109

c) water distribution network to be defined. Table 15 shows the determinations and sampling frequencies per size of city and per part of the water supply system.

One consideration in designing the analytical programs for each locality may be that in systems which disinfect their waters and serve populations of more than 50,000 inhabitants, the frequency of bacteriological sampling can be reduced providing that chlorine residual determinations be carried out at the most distant points of the distribution network.

In the specific case of the surveillance programs under the responsibility of the health authorities, it is planned to perform the analyses indicated in Table 16. The level of surveillance to be implemented has been defined in keeping with the analytical capacity of the laboratories the authorities have available in the country, and it is roughly estimated that it can correspond to 10% of the analyses performed by the suppliers.

The sampling frequency for bacteriological and physical-chemical determinations in water quality surveillance is shown in Tables 17 and 18.

7.7.3 Sanitary Inspections

The sanitary inspections will be the responsibility of the water suppliers, both public and private, and of the municipal authorities who administer their water supply services. The recommended frequency for these inspections is shown in Table 19. The surveillance authority will be responsible for verifying the quality of the information by means of audits of the inspection units.

110 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 15. Number of Determinations per Type of Locality (samples per year)

Large cities Medium cities Small cities Towns Rural Determinations Plant Reserv Distrib Plant Reserv Distrib Plant Reserv Distrib Plant Reserv Distrib Plant Reserv Distrib Basic level Turbidity 365 365 52 180 48 26 12 12 12 6 6 1 4 pH value 365 365 52 180 48 26 12 12 12 6 6 1 4 Chlorine residual 1460 365 365 180 365 52 52 105 52 26 12 6 4 Thermotoler. coli 365 52 26 180 52 26 52 52 26 6 12 2 4 Affecting organoleptic quality Color 52 12 4 24 6 1 4 4 2 0.5 Hardness 52 12 4 24 6 1 4 4 2 0.5 Chlorides 52 12 4 24 6 1 4 4 2 0.5 Sulphate 52 12 4 24 6 1 4 4 2 0.5 Dissolved solids 52 12 4 24 6 1 4 4 2 0.5 Iron 52 12 4 24 6 1 4 4 2 0.5 Manganese 52 12 4 24 6 1 4 4 2 0.5 Inorganics which affect health Arsenic 4 1 4 1 1 0.5 Cadmium 4 1 4 1 1 0.5 Cyanide 4 1 4 1 1 0.5 Chromium 4 1 4 1 1 0.5 Mercury 4 1 4 1 1 0.5 Lead 4 1 4 1 1 0.5 Selenium 4 1 4 1 1 0.5 Aluminum 4 1 4 1 1 0.5 Copper 4 1 4 1 1 0.5 Zinc 4 1 4 1 1 0.5 Sodium 4 1 4 1 1 0.5 Nitrate 12 4 12 1 1 0.5 Fluoride 12 4 12 1 1 0.5 Organics which affect health Chlorinated alkanes 2 0.5 Chlorinated ethenes 2 0.5 Aromatic hydrocarbons 2 0.5 Polynuclears 2 0.5 Chlorobenzenes 2 0.5 Pesticides 2 0.5 Phenols and chlorophenols 2 0.5 Trihalometanes 2 0.5 Benzene and lower alkylbenzenes 2 0.5

National Program for the Surveillance and Quality Control of Drinking Water 111

Table 16. Analytical Determinations per Level of Surveillance

Piped water Level I II III IV V Disinfected water Feeder main A B+A C+A D+A E+A Distribution A B+A C+A D+A E+A Public standpipe A B+A ------Non-disinfected water Feeder main B C D E --- Distribution B C D E --- Public standpipe B ------

Non-piped Level I II III IV V Disinfected water Tank truck A B+A C+A ------Non-disinfected water Tank truck B B+A C+A ------

Key A = Chlorine residual B = Thermotolerant coliforms + Turbidity C = B + components that affect the organoleptic quality of the water D = C + inorganic components with health impact E = D + organic components with health impact

Table 17. Frequency of Bacteriological Sampling per Level (samples per year)

Level Size of population I II III IV V Rural area 0 1 2 100 – 2,500 inhab Towns 0 1 2 4 2,500 – 10,000 inhab Small cities 0 1 2 4 12 10,000 – 50,000 inhab Medium cities 1 2 4 12 26 50,000 – 200,000 inhab Large cities 2 4 12 26 52 Over 200,000 – inhab

112 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 18. Frequency of Physico-Chemical Sampling per Level (number of samples per year)

Level Size of population Surface Groundwater I II III IV V I II III IV V Rural area 2 1 100 – 2,500 inhab Towns 2 4 1 2,500 – 10,000 inhab Small cities 2 4 12 1 2 10,000 – 50,000 inhab Medium cities 2 4 12 26 1 2 50,000 – 200,000 inhab Large cities 2 4 12 26 52 1 2 4 Over 200,000 – inhab

Table 19. Frequency of Sanitary Inspections per Level

Level Size of population I II III IV V Rural area Every other 0 Annually 100 – 2,500 inhab year Towns 0 Annually Half-yearly 2,500 – 10,000 inhab Small cities 0 Annually Half-yearly 10,000 – 50,000 inhab Medium cities Annually Half-yearly Quarterly 50,000 – 200,000 inhab Large cities Annually Half-yearly Quarterly Over 200,000 – inhab

7.8 Surveillance and Control Programs

7.8.1 General

In drawing up the present Program, two groups of programs have been considered:

a) Operational Programs; and b) Support Programs.

These programs should be developed jointly by the Ministry of Health and the public and private supply agencies, including the municipal administrations and rural councils responsible for the management of rural systems.

National Program for the Surveillance and Quality Control of Drinking Water 113

7.8.2 Programs

To meet the goal of improving the quality of life, the Program will conduct a series of surveillance and control activities. Independently of these activities, it is indispensable that investment programs be executed to extend the coverage of the water and sanitation services, and to increase the control of vectors, foodstuffs and public establishments, among others.

The programs designed to help in the application of surveillance throughout the country have been grouped as follows:

7.8.3 Operational Programs

Program 1 Sanitary inspection and assessment of services Program 2 Analysis of water quality Program 3 Institutional assessment.

7.8.4 Support programs

Program 4 Institutional development Program 5 Legal bases Program 6 Development of human resources Program 7 Environmental education Program 8 Environmental epidemiological surveillance Program 9 Community surveillance Program 10 Information.

7.9 Operational Programs

7.9.1 Program 1: Sanitary inspection and assessment of services

This program seeks to determine and catalog the risk posed by the water supply facilities in urban and rural areas, and to inform the pertinent institutions of any problems detected, so that corrective measures may be taken to improve the quality of the water service.

The program includes:

a) Census of each of the communities with a water supply service. b) Evaluation of the facilities in order to catalog and qualify their capacity of response to the Program for the Surveillance and Quality Control of Drinking Water. c) Sanitary inspection of the water supply systems to determine the risk level of the facilities. d) Evaluation of health hazard. e) Assessment of the quality and levels of service.

114 Guidelines for the Surveillance and Control of Drinking Water Quality

7.9.2 Program 2: Analysis of Water Quality

This program is designed to ensure the good quality of the water for human consumption.

The program includes:

a) Drawing-up and establishment of quality standards b) Implementation of laboratories c) Establishment of the sampling system and execution of the water-sampling and testing program. d) Development of the analytical quality control program.

7.9.3 Program 3: Institutional Assessment

The surveillance agency or the regulatory agency, as the case may be, will be in charge of this assessment program, which seeks to analyze the organization and the physical, economic, and staff resources assigned by the supply agencies to their programs for drinking water quality control.

The program comprises:

a) Institutional organization b) Operational capacity.

7.10 Support Programs

7.10.1 Program 4: Institutional Development

This program seeks to organize the system for the surveillance of the quality of drinking water services as an element of coordination, supervision and management of the activities and efforts undertaken to determine the risks posed by the different water supply systems, with a view to improving their quality.

The program will be developed through three projects:

a) Institutionalization of the national surveillance system b) Development of the system for data processing and reporting, notification, and control c) Strengthening of the executing and coordinating agencies at the regional level.

This latter project should be complemented with the following areas:

c.1) Project management c.2) Financial management

National Program for the Surveillance and Quality Control of Drinking Water 115

7.10.2 Program 5: Legal Bases

A key to the success of the Surveillance and Control Program is the existence of legal provisions favorable to its execution. To this effect three tasks have been identified:

a) Revision of current laws concerning the rendering of water supply services b) Promulgation of new legal provisions to make the execution of the Program viable c) Setting of complementary standards.

7.10.3 Program 6: Development of Human Resources

This activity seeks to train sufficient human resources in the different institutions to ensure that they will be capable of doing the work required of them.

This program comprises:

a) Census of staff assigned to surveillance work b) Register of national and international institutions that provide training c) Determination of staff requirements of the surveillance agency and of water supply agencies d) Training requirements geared to future needs e) Design and validation of the training modules f) Design of the national and institutional training program.

7.10.4 Program 7: Environmental Education

This program is designed to raise the population's awareness of the positive health impact of good quality drinking water, hygienic disposal of excreta, and other hygienic habits and customs. It involves carrying out individual, group, and mass communication activities. It will also promote the proper use of water and the protection of water resources, through hygiene education programs.

The Program comprises:

a) School education b) Mass communication by radio and television c) Training at public health establishments.

7.10.5 Program 8: Environmental Epidemiological Surveillance

Environmental epidemiological surveillance is designed to identify the diseases that are linked with the quality of the water or the quality of water services. This information will make it possible to determine the health impact of water quality and other factors, and it can also be used to identify any remedial actions that need to be taken in the operational, constructional and maintenance procedures of the different parts of the water supply system. It also determines the

116 Guidelines for the Surveillance and Control of Drinking Water Quality

impact of the building materials used in the water supply infrastructure and of the chemicals used in treating the water. Finally, it is a tool that will help the sectors involved to set investment priorities that reflect the anticipated impact on public health. The tasks identified are:

a) To revise and extend the list of notifiable diseases, in order to assess the impact of the water quality and the quality of the water supply service on the health of the consumers b) To develop a system for the evaluation of epidemiological information.

7.10.6 Program 9: Community Surveillance

This program seeks to organize citizens' Surveillance Committees and to encourage the appropriate, active participation of the inhabitants of urban, peri-urban, and rural areas through these committees.

In urban areas, the committees will be responsible for demanding that the suppliers provide safe water of the quality stipulated in the standards or specified by the sanitary authorities. In peri-urban and rural areas, they will be responsible for demanding that compliance be given to the observations made by the sanitary authorities for the improvement of the quality of the water supply service.

The program comprises:

a) Identification of the hierarchies of authorities present in the different regions b) Design of the system for the participation of the Surveillance Committees c) Training of the members of the Surveillance Committees.

7.10.7 Program 10: Information

Generally speaking, the data in themselves are of very little value. They need to be validated, carefully stored in a data base, and evaluated to produce information that will be useful to the parties interested in preserving and conserving human health by improving the quality of the services, rehabilitating the systems, or extending the coverage of the water supply.

The information, used in conjunction with the results of the environmental epidemiological surveillance, should also serve to determine the risk to which the users of the water supply service are exposed, and to update standards, rules or other types of regulatory or legal instruments relative to the water supply.

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7.11 Options for Implementing Surveillance Nationwide

The options proposed are based on the following premises:

Based on water quality standards, the analyses to be effected and the sampling frequency have already been established.

• The following parties took part in proposing options for the levels of intervention: the health authorities, the regulatory agency and the suppliers. Different levels of compliance have also been established by consensus. For the definition of future levels of intervention, the present situation was taken into account.

• The analytical determinations and the sampling frequencies have been grouped according to the size of the community and the main components of the water supply system.

• During the initial stage, emphasis will be placed on sanitary inspection. The evaluation of the bacteriological quality of the water will gradually be increased, as well as the control of chlorine residual and of the basic physical-chemical parameters.

Table 20 shows the level of the water quality control programs in the year 2000 and the different levels of goals set to the year 2010, giving rise to six intervention options. These goals have been defined bearing in mind the maximum demands indicated in The Country's water quality standard.

Table 20. Present Situation of the Programs for the Control of Water Quality and Options for Future Interventions (expressed as a percentage of compliance with water quality standards)

Situation Options to the year 2010 Size of population in year 2000 1 2 3 4 5 6 Rural area 2 10 20 35 40 50 100 100 – 2,500 inhab Towns 5 20 40 50 60 70 100 2,500 – 10,000 inhab Small cities 10 35 60 70 75 85 100 10,000 – 50,000 inhab Medium cities 25 55 80 90 95 95 100 50,000 – 200,000 inhab Large cities 50 75 90 95 100 100 100 Over 200,000 inhab

In medium cities with 50,000 to 200,000 inhabitants, as well as in large cities with over 200,000 inhabitants, the service providers will have to assume the total cost of drinking water quality control.

National Program for the Surveillance and Quality Control of Drinking Water 119

CHAPTER III

8. Investment and Costs of Execution of the Surveillance and Control of Drinking Water and of the Water Supply Services

8.1 Criteria for the Determination of Basic Costs

The following criteria were used to determine the cost of implementing the Program for the surveillance and control of the quality of the water and of the water supply services.

Sampling and Sanitary Inspection

The cost of sample collection and sanitary inspections, depending on the size of the population, is shown in Table 21. For rural populations, the calculation includes the per diem expenses of the sampler and the driver, and the fuel and maintenance costs of the vehicles. For urban areas, the calculation includes only the fuel and maintenance costs.

Table 21. Cost per Sample Taken (in US$)

Size of population Cost

Rural area 15.00 100 – 2,500 inhab Towns 7.50 2,500 – 10,000 inhab Small cities 3.50 10,000 – 50,000 inhab Medium cities 2.00 50,000 – 200,000 inhab Large cities 1.50 Over 200,000 inhab

Frequency of Sanitary Inspections

The frequency of sanitary inspections was defined based on the size of the population, as indicated in Table 19. The productivity of the inspectors is shown in Table 22.

120 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 22. Number of Sanitary Inspections to be Effected per Day and per Inspector

Number Size of population (days/man) Rural area 1 100 – 2,500 inhab Towns 2 2,500 – 10,000 inhab Small cities 4 10,000 – 50,000 inhab Medium cities 7 50,000 – 200,000 inhab Large cities 14 over 200,000 inhab

Analyses

Table 23 summarizes the cost per type of laboratory of the physico-chemical and bacteriological analyses included in the surveillance and control program. The details are given in Table 24, where the types and cost of each of the determinations to be applied in the surveillance and control program are indicated, grouped by type of laboratory. Table 25, in turn, shows the cost per year of the determinations for the principal parts of the water supply system (outlet of treatment plant, storage reservoirs, and distribution network) and per size of population. Table 26 shows the details of the global costs taking into account the number of samples to be performed per year as indicated in Table 15.

Table 23. Cost of Determinations per Type of Laboratory

Type of Laboratory US$ Basic level - Local laboratory 3.60 Intermediate level - Regional laboratory-intermediate Factors affecting organoleptic quality 15.00 Intermediate level - Regional laboratory-high Inorganic components which influence health 80.50 Reference laboratory Organic components which influence health 225.00

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Table 24. Determinations and Cost per Physico-Chemical and Bacteriological Analysis

Cost Laboratory Determination US$ Turbidity 0.50 Local laboratory pH value 0.50 Basic Chlorine residual 0.10 Thermotolerant coliforms 2.50

Color 1.00 Hardness 1.50 Chlorides 1.50 Intermediate level regional laboratory Sulphate 2.00 Factors wich affect organoleptic quality Dissolved solids 2.00 Iron 3.50 Manganese 3.50

Arsenic 5.00 Cadmium 5.00 Cyanide 10.00 Chromium 3.50 Mercury 10.00 Lead 5.00 High level regional laboratory Selenium 10.00 Inorganics which affect health Aluminum 7.00 Copper 5.00 Zinc 5.00 Sodium 5.00 Nitrate 5.00 Fluoride 5.00

Chlorinated alkanes 25.00 Chlorinated ethenes 25.00 Aromatic hydrocarbons 25.00 Polynuclears 25.00 Reference laboratory Chlorobenzenes 25.00 Organics which affect health Pesticides 25.00 Phenols and chlorophenols 25.00 Trihalometanes 25.00 Benzene and lower 25.00 alkylbenzenes

NOTE. It is assumed that the better-equipped laboratories, in addition to conducting the above determinations, perform the analytical determinations of the lower level laboratories.

122 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 25. Cost of Determinations per Size of Community and per Year (in US$)

Water treatment Distribution Size of population Reservoir plant network Rural area 0.00 54.35 14.40 100 – 2,500 inhab Towns 80.50 53.60 37.20 2,500 – 10,000 inhab Small cities 287.70 212.50 82.20 10,000 – 50,000 inhab Medium cities 1,522.50 304.50 111.20 50,000 – 200,000 inhab Large cities 3,055.50 822.00 213.50 over 200,000 – inhab

Table 26. Cost of Analysis per Year and per Type of Locality (in US$)

Unit Large cities Medium cities Small cities Towns Rural Determinations Costs Plants Reserv Distrib Plants Reserv Distrib Plants Reserv Distrib Plants Reserv Distrib Reserv Distrib Basic level Turbidity 0.50 182.50 182.5 26.00 90.00 24.00 13.00 6.00 6.00 6.00 3.00 3.00 0.50 2.00 pH value 0.50 182.50 182.50 26.00 90.00 24.00 13.00 6.00 6.00 6.00 3.00 3.00 0.50 2.00 Chlorine residual 0.10 146.00 36.50 36.50 18.00 36.50 5.20 5.20 10.50 5.20 2.60 1.20 0.60 0.40 Thermotolerant coliforms 2.50 912.50 130.00 65.00 450.00 130.00 65.00 130.00 130.00 65.00 15.00 30.00 5.00 10.00 Affecting organoleptic quality Color 1.00 52.00 12.00 4.00 24.00 6.00 1.00 4.00 4.00 2.00 0.50 Hardness 1.50 78.00 18.00 6.00 36.00 9.00 1.50 6.00 6.00 3.00 0.75 Chlorides 1.50 78.00 18.00 6.00 36.00 9.00 1.50 6.00 6.00 3.00 0.75 Sulphate 2.00 104.00 24.00 8.00 48.00 12.00 2.00 8.00 8.00 4.00 1.00 Dissolved solids 2.00 104.00 24.00 8.00 48.00 12.00 2.00 8.00 8.00 4.00 1.00 Iron 3.50 182.00 42.00 14.00 84.00 21.00 3.50 14.00 14.00 7.00 1.75 Manganese 3.50 182.00 42.00 14.00 84.00 21.00 3.50 14.00 14.00 7.00 1.75 Inorganics which affect health Arsenic 5.00 20.00 5.00 20.00 5.00 5.00 2.50 Cadmium 5.00 20.00 5.00 20.00 5.00 5.00 2.50 Cyanide 10.00 40.00 10.00 40.00 10.00 10.00 5.00 Chromium 3.50 14.00 3.50 14.00 3.50 3.50 1.75 Mercury 10.00 40.00 10.00 40.00 10.00 10.00 5.00 Lead 5.00 20.00 5.00 20.00 5.00 5.00 2.50 Selenium 10.00 40.00 10.00 40.00 10.00 10.00 5.00 Aluminum 7.00 28.00 7.00 28.00 7.00 7.00 3.50 Copper 5.00 20.00 5.00 20.00 5.00 5.00 2.50 Zinc 5.00 20.00 5.00 20.00 5.00 5.00 2.50 Sodium 5.00 20.00 5.00 20.00 5.00 5.00 2.50 Nitrate 5.00 60.00 20.00 60.00 5.00 5.00 2.50

Unit Large cities Medium cities Small cities Towns Rural Determinations Costs Plants Reserv Distrib Plants Reserv Distrib Plants Reserv Distrib Plants Reserv Distrib Reserv Distrib Fluoride 5.00 60.00 20.00 60.00 5.00 5.00 2.50 Organics which affect health Chlorinated alkanes 25.00 50.00 12.50 Chlorinated ethenes 25.00 50.00 12.50 Aromatic hydrocarbons 25.00 50.00 12.50 Polynuclears 25.00 50.00 12.50 Chlorobenzenes 25.00 50.00 12.50 Pesticides 25.00 50.00 12.50 Phenols and chlorophenols 25.00 50.00 12.50 Trihalometanes 25.00 50.00 12.50 Benzene and lower 25.00 50.00 12.50 alkylbenzenes TOTAL 3,055.50 822.00 213.50 1522.50 304.50 111.20 287.70 212.50 82.20 80.50 53.60 37.20 54.35 14.40

National Program for the Surveillance and Quality Control of Drinking Water 125

Laboratory Equipment

Table 27 summarizes the approximate cost in equipment and instruments of setting up different types of laboratories, and Table 29 contains the breakdown of these costs.

Table 27. Cost of Equipping Laboratories

Level of Laboratory US$ Basic level - Local laboratory 3,800 Intermediate level - Regional laboratory-intermediate Factors affecting organoleptic quality 39,000 Intermediate level - Regional laboratory-high Inorganic components which influence health 70,500 Reference laboratory Organic components which influence health 323,000

Monthly Salaries and Wages

Table 28 indicates the labor cost considered for the tasks of sampling and data processing.

Table 28. Cost of Staff (in US$)

Staff Monthly salary Professional 1,200 Inspector 300 Driver 200 Secretary 150

126 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 29. Cost of Equipping Laboratories per Level of Intervention

Unit cost Total cost Level of laboratory Basic equipment and instruments US$ US$ Portable incubator 3,600 3,800 Local laboratory Basic Chlorine comparator 50 Basic turbidimeter 150

Still 3,000 39,000 Nephelometric turbidimeter 2,500 Spectrophotometer 5,000 Analytical balance 8,000 Intermediate level regional laboratory Incubator 4,500 Factors that affect organoleptic quality Stove 2,500 Glassware 3,000 Reagents 2,500 Furniture 5,000 Others 3,000

Evaporating dish 2,500 70,500* Fume hood 10,000 31,500 Glassware 3,000 High level regional laboratory Inorganics that affect health Ion meter 5,000 Reagents 3,000 Furniture 5,000 Others 3,000

Spectrophotometer UV/VIS 30,000 323,000 Spectrophotometer A.A. 80,000 Gas chromatograph 100,000 Analytical balance 8,000 Still 3,000 Nephelometric turbidimeter 2,500 Stove 5,000 Incubators 10,000 Evaporating dish 2,500 Fume hood 10,000 Ion meter 5,000 Reagents 30,000 Glassware 10,000 Miscellaneous equipment 10,000 Reference laboratory Furniture 10,000 Organics that affect health Others 7,000

* Including the cost of the intermediate level regional laboratory which performs the determinations affecting organoleptic quality.

National Program for the Surveillance and Quality Control of Drinking Water 127

Transportation

The cost of each of the vehicles required to support the surveillance tasks is shown in Table 30.

Table 30. Cost of Vehicles (in US$)

VEHICLE COST

Four-wheel drive 32,000 Pick-up van 18,000 Motorcycle 2.000

8.2 Cost of the Program

The following factors were taken into account in determining the cost:

a) Population growth according to Census Institute. See Table 2. b) Number of communities in 2000 and projected to 2010. See Table 3. c) Population to be served in the coming 10 years. See Table 31. d) Projected coverage in water supply. See Table 31. e) Projection of the number of communities to be attended to with water services (2000-2010). See Table 32. f) Number of localities, components per locality, and total components. See Table 33. g) Number of physico-chemical and bacteriological samples per year and per size of community. See Table 34. h) Number of physico-chemical and bacteriological determinations to be analyzed per year and per size of community. See Table 15. i) Number of sanitary inspections to be performed per year and per size of community. See Table 35. j) Staff required for carrying out sampling and sanitary inspections, per size of community. k) Laboratory equipment. See Table 27. l) Transportation requirements and portable laboratory equipment. m) Global estimate of the support programs.

128 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 31. Projection of the Population to be Served with Water Supply Services (in thousands)

Projected population Projected coverage (%) Population to be served Year Total Urban Rural Total Urban Rural Total Urban Rural 2001 26,319 18,405 7,908 51.9 63.1 25.9 13,672 11,619 2,047 2002 26,952 18,929 8,013 54.5 65.7 28.1 14,690 12,428 2,250 2003 27,601 19,469 8,119 57.2 68.3 30.5 15,785 13,294 2,474 2004 28,265 20,023 8,226 60.0 71.0 33.1 16,960 14,220 2,720 2005 28,945 20,594 8,335 63.0 73.9 35.9 18,223 15,211 2,990 2006 29,642 21,181 8,445 66.1 76.8 38.9 19,581 16,270 3,287 2007 30,355 21,784 8,556 69.3 79.9 42.2 21,039 17,403 3,613 2008 31,086 22,405 8,669 72.7 83.1 45.8 22,607 18,616 3,972 2009 31,834 23,043 8,784 76.3 86.4 49.7 24,291 19,912 4,366 2010 32,600 23,700 8,900 80.1 89.9 53.9 26,100 21,300 4,800

Table 32. Projection of Communities with Water Supply Services

Year Communities 2000 2001 2002 2004 2006 2008 2010 100 - 199 463 518 579 725 909 1,138 1,425 200 – 499 798 917 1,053 1,391 1,836 2,424 3,200 500 – 999 782 829 879 987 1,109 1,246 1,400 1,000 – 2,499 415 426 438 461 486 512 540 2,500 – 4,999 251 252 253 255 257 259 261 5,000 – 9,999 93 98 102 113 124 136 150 10,000 – 19,999 42 46 50 59 69 82 97 20,000 – 49,999 45 47 49 54 59 65 71 50,000 – 99,999 27 28 30 33 37 41 45 100,000 – 199,999 16 17 17 19 21 23 25 200,000 – 499,000 10 10 11 12 13 15 16 over 500,000 6 6 7 7 8 9 10

TOTAL 2,948 3,194 3,468 4,116 4,928 5,949 7,240

National Program for the Surveillance and Quality Control of Drinking Water 129

Table 33. Number of Localities, Components per Locality and Total Components Present Situation (Year 2001)

Number of Components per system Total components Size of population localities PLANT RES NET PLANT RES NET Rural area 2,690 1 1 1 2,690 2,690 2,690 100 – 2,500 inhab Towns 350 1 1 1 350 350 350 2,500 – 10,000 inhab Small cities 93 2 2 3 186 186 278 10,000 – 50,000 inhab Medium cities 45 5 15 15 226 677 677 50,000 – 200,000 inhab Large cities 17 10 50 50 168 840 840 Above 200,000 – inhab TOTAL 3,194 3,619 4,742 4,835

Future Situation (Year 2010)

Size of population Number of Components per system Total components localities PLANT RES NET PLANT RES NET Rural area 6,565 1 1 1 6,565 6,565 6,565 100 – 2,500 inhab Towns 411 1 1 1 411 411 411 2,500 – 10,000 inhab Small cities 168 2 2 3 336 336 504 10,000 – 50,000 inhab Medium cities 70 5 15 15 350 1,050 1,050 50,000 – 200,000 inhab Large cities 26 10 50 50 260 1300 1,300 Above 200,000 – inhab TOTAL 7,240 7,922 9,662 9,830

Table 34. Number of Samples to be Obtained for Water Quality Control Present Situation (Year 2001)

Number of samples per Components per system Total components components Total samples Size of population Number of localities PLANT RES NET PLANT RES NET PLANT* RES NET PLANT RES NET TOTAL Rural area 2,690 1 1 1 2,690 2,6902,690 0 4 0 0 10,760 0 10,760 100 – 2,500 inhab Towns 350 1 1 1 350 350 350 0 12 0 0 4,194 0 4,194 2,500 – 10,000 inhab Small cities 93 2 2 3 186 186 278 0 52 26 0 9,648 7,236 16,884 10,000 – 50,000 inhab Medium cities 45 5 15 15 226 677 677 0 52 26 0 35,213 17,607 52,820 50,000 – 200,000 inhab Large cities 17 10 50 50 168 840 840 0 52 26 0 43,669 21,834 65,503 Above 200,000 – inhab 3,194 3,619 4,7424,835 0 103,484 46,677 150,161 TOTAL

Future Situation (Year 2010)

Number of samples per Number of Components per system Total components Total samples component TOTAL Size of population localities PLANT RES NET PLANT RES NET PLANT* RES NET PLANT RES NET Rural area 6,565 1 1 1 6,565 6,565 6,565 0 4 0 0 26,260 0 26,260 100 – 2,500 inhab Towns 411 1 1 1 411 411 411 0 12 0 0 4,932 0 4,932 2,500 – 10,000 inhab Small cities 168 2 2 3 336 336 504 0 52 26 0 17,472 13,104 30,576 10,000 – 50,000 inhab Medium cities 70 5 15 15 350 1,050 1,050 0 52 26 0 54,600 27,300 81,900 50,000 – 200,000 inhab Large cities 26 10 50 50 260 1,300 1,300 0 52 26 0 67,600 33,800 101,400 Above 200,000 – inhab TOTAL 7,240 7,922 9,662 9,830 0 170,864 74,204 245,068 * Samples in the plants are taken by the operators, so there is no cost to the control program.

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Table 35. Number of Sanitary Inspections Present Situation (Year 2001)

Components Total Total Size of population Number of Frequency per system Components inspec- localities Times/year PLANT RES PLANT RES TOT tions Rural area 2,690 1 1 2,690 2,690 5,380 1 5,380 100 – 2,500 inhab Towns 350 1 1 350 350 699 2 1,398 2,500 – 10,000 inhab Small cities 93 2 2 186 186 371 2 742 10,000 – 50,000 inhab Medium cities 45 5 15 226 677 903 4 3,612 50,000 – 200,000 inhab Large cities 17 10 50 168 840 1,008 4 4,031 Above 200,000 – inhab TOTAL 3,194 3,619 4,742 8,361 15,163

Future Situation (Year 2010)

Components Total Total Number of Frequency Size of population per system components inspec- localities Times/year PLANT RES PLANT RES TOT tions Rural area 6,565 1 1 6,565 6,565 13,130 1 13,130 100 – 2,500 inhab Towns 411 1 1 411 411 822 2 1,644 2,500 – 10,000 inhab Small cities 168 2 2 336 336 672 2 1,344 10,000 – 50,000 inhab Medium cities 70 5 15 350 1,050 1,400 4 5,600 50,000 – 200,000 inhab Large cities 26 10 50 260 1,300 1,560 4 6,240 Above 200,000 – inhab TOTAL 7,240 7,922 9,662 17,584 27,958

132 Guidelines for the Surveillance and Control of Drinking Water Quality

In addition, different levels of participation have been planned for the agencies responsible for the control program. In the case of rural populations, it is the Ministry of Health or other pertinent institution that sees to this task, while for the large and medium cities it is the providers of the sanitation service. Table 36 indicates the percentages of participation of each of the institutions involved in the drinking water quality control activities.

Table 36. Percentage of Participation of Institutions in the Drinking Water Quality Control Activities

Size of population Ministry of health Supplier Rural area 100 0 100 – 2,500 inhab Towns 50 50 2,500 – 10,000 inhab Small cities 10 90 10,000 – 50,000 inhab Medium cities 0 100 50,000 – 200,000 inhab Large cities 0 100 Over 200,000 inhab

Also, in defining the participation of surveillance agencies, the level of participation in each of the lines of action was established, as shown in Table 37. No investment in laboratory was considered for the surveillance program, because the Ministry of Health is to enlarge the capacity of the reference laboratory and of the regional laboratories. These laboratories should then support the water quality control tasks and the water quality surveillance work independently.

Table 37. Percentage of Participation of the Surveillance Agency per Line of Action

Lines of action Rural Urban Analysis 3 10 Sanitary inspection 3 10 Sampling 3 10 Laboratory 0 15 Transportation 10 10

The investment required to attend to each of the previously identified options in the period 2001 - 2010 is summarized in Table 38, and it fluctuates between 26.6 and 49.2 million dollars. Tables 39 and 40 show the investment per option that needs to be made by each of the institutions responsible, noting that between 21.7% and 30.6% of the budgeted amount will have to be assumed by the institution responsible for the rural area and small localities, from 70.9% to 62.0% by the providers of the sanitation services, and approximately 7.6% by the surveillance agency itself.

National Program for the Surveillance and Quality Control of Drinking Water 133

Should it be decided, however, to carry out surveillance only in the large and medium cities, that is, in those areas under the jurisdiction of the providers of sanitation services, the budget would drop by 24%, with an average of 91.3% of the investment corresponding to the suppliers, and 8.7% to the surveillance agency. See Table 41. Tables 42 to 44 give a breakdown of the investments for analysis, sanitary inspection, and sampling, and Tables 45 and 46 specify the investments required for carrying out the control and the surveillance of water quality.

Table 38. Total Cost of the Program for the Surveillance and Control of Water Quality (2001 – 2010)

Options Item 1 2 3 4 5 6 Analysis 16,494,909 1,9484,058 20,745,238 21,559,789 21,850,773 2,3131,701 Sanitary inspection 188,138 281,947 384,172 420,823 483,100 765,184 Sampling 1,613,002 2,129,118 2,475,760 2,625,937 2,811,363 3,573,407 Laboratories 3,409,965 4,414,917 5,449,381 6,518,601 7,628,758 9,163,350 Transportation 2,683,230 3,476,744 4,342,872 5,294,520 6,346,892 8,443,600 Subtotal 24,389,243 29,786,784 3,339,7421 36,419,671 39,120,885 45,077,242 10% Support 2,241,068 2,732,741 3,063,092 3,337,853 3,585,009 4,140,854 Total 26,630,311 32,519,525 36,460,513 39,757,523 42,705,894 4,921,8096 Millions 26.63 32.52 36.46 39.76 42.71 49.22

Table 39. Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001 – 2010 (in US$)

Line of action Options 1 2 3 4 5 6 Quality control Min. of health 5,784,402 6,858,623 8,185,567 9,218,726 10,606,491 15,045,236 Supplier 18,867,345 23,201,533 25,508,443 27,497,654 28,828,608 30,504,155 Subtotal 24,651,747 30,060,156 33,694,010 36,716,380 39,435,100 45,549,390 Surveillance Min. of health 226,876 277,189 338,129 395,457 467,637 676,751 Supplier 1,751,688 2,182,180 2,428,374 2,645,687 2,803,158 2,991,955 Subtotal 1,978,564 2,459,369 2,766,503 3,041,143 3,270,795 3,668,706 Total 26,630,311 32,519,525 36,460,513 39,757,523 42,705,894 49,218,096 Millions 26.63 32.52 36.46 39.76 42.71 49.22

134 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 40. Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001 – 2010 (percentage)

Options Line of action 1 2 3 4 5 6 Quality control Min. of health 21.72 21.09 22.45 23.19 24.84 30.57 Supplier 70.85 71.35 69.96 69.16 67.50 61.98 Subtotal 92.57 92.44 92.41 92.35 92.34 92.55 Surveillance Min. of health 0.85 0.85 0.93 0.99 1.10 1.38 Supplier 6.58 6.71 6.66 6.65 6.56 6.08 Subtotal 7.43 7.56 7.59 7.65 7.66 7.45 Total 100.00 100.00 100.00 100.00 100.00 100.00

Table 41. Summary of Investment to Implement the Program for the Surveillance and Control of Drinking Water Quality 2001 – 2010 – Urban Areas (in US$)

Options Line of action 1 2 3 4 5 6 Quality control 18,867,345 23,201,533 25,508,443 27,497,654 28,828,608 30,504,155 Surveillance 1,751,688 2,182,180 2,428,374 2,645,687 2,803,158 2,991,955 Total 20,619,033 25,383,714 27,936,817 30,143,340 31,631,766 33,496,110 Millions 20.62 25.38 27.94 30.14 31.63 33.50 Percentage of investment Quality control 91.50 91.40 91.31 91.22 91.14 91.07 Surveillance 8.50 8.60 8.69 8.78 8.86 8.93

8.3 Recommended Option

Taking into consideration the investment amount, the country's economy, and the health situation, it is recommended that Option 4 be used. This Option considers 100% of intervention in the large cities, 95% in the medium cities, 75% in the small ones, 60% for the towns and 40% for rural communities, with an investment of 39.8 million dollars. The urban suppliers would assume 69.2% of the investment, the institution responsible for control in rural areas 23.26%, and the surveillance agency 7.7%. The surveillance agency's investment would amount to 3.0 million dollars, that is US$ 300,000 per year.

National Program for the Surveillance and Quality Control of Drinking Water 135

To ensure the reliability of the control activities, the health authorities should commission an independent institution to audit the work performed by the service providers, and should also demand that the suppliers' laboratories implement analytical quality control programs and start certifying these.

These measures will be conducive to joint efforts on the part of the surveillance agency and the supply agencies, and will translate into savings for the country since they will prevent duplication of efforts on the tasks of drinking water surveillance and drinking water quality control.

9. Origin and Application of Funds

For the surveillance of all the water services and the control of the small water suppliers by the Ministry of Health, which will cost 12,3 million dollars for the ten-year period, the suggested sources and number of funds have been considered.

Table 42. Cost of Analyses per Year and per Option (in US$)

Ministry of Health

Option Year 1 2 3 4 5 6 2001 8,320 9,833 11,789 12,314 13,666 19,681 2002 11,139 14,664 19,201 20,472 23,605 37,632 2003 14,460 20,613 28,500 30,803 36,248 60,782 2004 18,359 27,892 40,077 43,776 52,186 90,328 2005 22,919 36,752 54,394 59,953 72,129 127,718 2006 28,237 47,483 72,001 80,003 96,927 174,698 2007 34,423 60,430 93,547 104,725 127,593 233,372 2008 41,600 75,993 119,802 135,070 165,339 306,269 2009 49,908 94,640 151,674 172,170 211,609 396,429 2010 59,507 116,919 190,236 217,371 268,121 507,496 Subtotal 288,873 505,220 781,221 876,656 1.067,423 1.954,404 Millions 0.29 0.51 0.78 0.88 1.07 1.95

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Supplier

Option Year 1 2 3 4 5 6 2001 904,282 926,829 933,989 939,015 939,665 942,162 2002 998,757 1,049,184 1,065,458 1,076,954 1,078,445 1,084,184 2003 1,103,103 1,187,691 1,215,432 1,235,157 1,237,722 1,247,616 2004 1,218,351 1,344,483 1,386,516 1,416,599 1,420,523 1,435,683 2005 1,345,639 1,521,974 1,581,682 1,624,694 1,630,322 1,652,100 2006 1,486,226 1,722,896 1,804,320 1,863,358 1,871,107 1,901,140 2007 1,641,500 1,950,342 2,058,296 2,137,082 2,147,453 2,187,720 2008 1,812,997 2,207,815 2,348,021 2,451,015 2,464,613 2,517,500 2009 2,002,411 2,499,278 2,678,529 2,811,064 2,828,616 2,896,992 2010 2,211,615 2,829,219 3,055,559 3,224,003 3,246,378 3,333,689 Subtotal 14,724,882 17,239,710 18,127,801 18,778,940 18,864,843 19,198,787 Millions 14.72 17.24 18.13 18.78 18.86 19.20

Total 1,5013,755 17,744,930 18,909,021 19,655,596 19,932,266 21,153,190 Millions 15.01 17.74 18.91 19.66 19.93 21.15

Table 43. Cost of Sanitary Inspections per Year and per Option (in US$)

Ministry of Health

Option Year 1 2 3 4 5 6 2001 2,377 2,620 2,885 2,944 3,067 3,498 2002 3,152 3,779 4,477 4,643 4,983 6,214 2003 4,118 5,323 6,701 7,049 7,750 10,380 2004 5,315 7,368 9,782 10,427 11,705 16,692 2005 6,796 10,062 14,020 15,133 17,316 26,165 2006 8,621 13,596 19,816 21,651 25,224 40,278 2007 10,864 18,213 27,706 30,635 36,312 61,183 2008 13,615 24,224 38,405 42,966 51,792 92,004 2009 16,981 32,030 52,863 59,832 73,326 137,279 2010 21,093 42,138 72,344 82,832 103,190 203,585 Subtotal 92,932 159,353 248,999 278,113 334,667 597,277 Millions 0.093 0.159 0.249 0.278 0.335 0.597

National Program for the Surveillance and Quality Control of Drinking Water 137

Supplier

Option Year 1 2 3 4 5 6 2001 4,638 4,812 4,870 4,906 4,927 4,984 2002 5,225 5,624 5,759 5,846 5,896 6,034 2003 5,886 6,573 6,812 6,965 7,056 7,305 2004 6,631 7,683 8,057 8,300 8,443 8,843 2005 7,470 8,979 9,529 9,889 10,104 10,706 2006 8,416 10,494 11,270 11,784 12,091 12,961 2007 9,481 12,265 13,330 14,041 14,469 15,690 2008 10,681 14,335 15,766 16,731 17,314 18,995 2009 12,032 16,755 18,647 19,935 20,719 22996 2010 13,555 19,582 22,054 23,754 24,794 27,839 Subtotal 84,016 107,103 116,093 122,151 125,812 136,353 Millions 0.084 0.107 0.116 0.122 0.126 0.136 Total 176,948 266,456 365,092 400,264 460,479 733,631 Millions 0.177 0.266 0.365 0.400 0.460 0.734

Table 44. Cost of Sampling per Year and per Option (in US$)

Ministry of Health

Option Year 1 2 3 4 5 6 2001 5,875 6,649 7642 7,887 8,453 10,741 2002 7,823 9,730 12,172 12,807 14,227 20,077 2003 10,188 13,699 18,198 19,427 22,096 33,306 2004 13,047 18,774 26,137 28,241 32,697 51,778 2005 16,490 25,224 36,513 39,878 46,845 77,276 2006 20,622 33,380 49,981 55,130 65,583 112,145 2007 25,566 43,644 67,364 75,001 90,238 159,464 2008 31,467 56,512 89,688 100,754 122,499 223,272 2009 38,491 72,585 118,236 133,981 164,510 308,850 2010 46,835 92,599 154,604 176,683 218,993 423,097 Subtotal 216,402 372,796 580,534 649,789 786,141 1.420,006 Millions 0.22 0.37 0.58 0.65 0.79 1.42

138 Guidelines for the Surveillance and Control of Drinking Water Quality

Supplier

Option Year 1 2 3 4 5 6 2001 69,945 72,402 73,191 73,634 73,879 74,450 2002 78,759 84,390 86,240 87,287 87,868 89,233 2003 88,684 98,363 101,616 103,472 104,507 106,951 2004 99,860 114,649 119,732 122,657 124,295 128,187 2005 112,445 133,633 141,079 145,399 147,831 153,639 2006 126,615 155,759 166,231 172,359 175,824 184,145 2007 142,571 181,549 195,868 204,317 209,117 220,708 2008 160,538 211,610 230,789 242,200 248,715 264,531 2009 180,769 246,648 271,935 287,108 295,810 317,056 2010 203,549 287,487 320,418 340,343 351,824 380,009 Su total 1,263,734 1,586,490 1707,100 1,778,776 1,819,671 1,918,910 Millions 1.26 1.59 1.71 1.78 1.82 1.92

Total 1,480,136 1,959,285 2,287,634 2,428,565 2,605,812 3,338,916 Millions 1.48 1.96 2.29 2.43 2.61 3.34

Table 45. Cost of Implementing Quality Control 2001 - 2010 (in US$)

Ministry of Health

Option Item 1 2 3 4 5 6 Analysis 288,873 505,220 781,221 876,656 1,067,423 1,954,404 Sanitary inspection 92,932 159,353 248,999 278,113 334,667 597,277 Sampling 216,402 372,796 580,534 649,789 786,141 1,420,006 Laboratories 2,571,040 2,737,067 2,932,606 3,162,901 3,434,133 4,129,800 Transport 2,089,300 2,460,676 2,898,065 3,413,200 4,019,902 5,576,000 Subtotal 5,258,547 6,235,112 7,441,424 8,380,660 9,642,265 13,677,487 Support 10% 525,855 623,511 744,142 838,066 964,226 1,367,749 Subtotal 5,784,402 6,858,623 8185567 9218726 10,606,491 15,045,236 Millions 5.78 6.86 8.19 9.22 10.61 15.05

National Program for the Surveillance and Quality Control of Drinking Water 139

Supplier

Option Item 1 2 3 4 5 6 Analysis 14,724,882 17,239,710 18,127,801 18,778,940 18,864,843 19,198,787 Sanitary inspection 84,016 107,103 116,093 122,151 125,812 136,353 Sampling 1,263,734 1,586,490 1,707,100 1,778,776 1,819,671 1,918,910 Laboratories 729,500 1,459,000 2,188,500 2,918,000 3,647,500 4,377,000 Transport 350,000 700,000 1,050,000 1,400,000 1,750,000 2,100,000 Subtotal 17,152,132 21,092,303 23,189,494 24,997,867 26,207,826 27,731,050 Support 10% 1,715,213 2,109,230 2,318,949 2,499,787 2,620,783 2,773,105 SubtotaL 18,867,345 23,201,533 25,508,443 27,497,654 28,828,608 30,504,155 Millions 18.87 23.20 25.51 27.50 28.83 30.50

Total

Option Item 1 2 3 4 5 6 Analysis 15,013,755 17,744,930 18,909,021 19,655,596 19,932,266 21,153,190 Sanitary inspection 176,948 266,456 365,092 400,264 460,479 733,631 Sampling 1,480,136 1,959,285 2,287,634 2,428,565 2,605,812 3,338,916 Laboratories 3,300,540 4,196,067 5,121,106 6,080,901 7,081,633 8,506,800 Transport 2,439,300 3,160,676 3,948,065 4,813,200 5,769,902 7,676,000 Subtotal 22,410,679 27,327,415 30,630,918 33,378,527 35,850,091 41,408,537 Support 10% 2,241,068 2,732,741 3,063,092 3,337,853 3,585,009 4,140,854 Subtotal 24,651,747 30,060,156 33,694,010 36,716,380 39,435,100 45,549,390 Millions 24.65 30.06 33.69 36.72 39.44 45.55

Table 46. Cost of Quality Surveillance 2001 - 2010 (in US$)

Ministry of Health

Option Item 1 2 3 4 5 6 Analysis 8,666 15,157 23,437 26,300 32,023 58,632 Sanitary inspection 2,788 4,781 7,470 8,343 10,040 17,918 Sampling 6,492 11,184 17,416 19,494 23,584 42,600 Laboratories 0 0 0 0 0 0 Transport 208,930 246,068 289,807 341,320 401,990 557,600 Subtotal 226,876 277,189 338,129 395,457 467,637 676,751 Millions 0.23 0.28 0.34 0.40 0.47 0.68

140 Guidelines for the Surveillance and Control of Drinking Water Quality

Supplier

Option Item 1 2 3 4 5 6 Analysis 1,472,488 1,723,971 1,812,780 1,877,894 1,886,484 1,919,879 Sanitary inspection 8,402 10,710 11,609 12,215 12,581 13,635 Sampling 126,373 158,649 170,710 177,878 181,967 191,891 Laboratories 109,425 218,850 328,275 437,700 547,125 656,550 Transport 35,000 70,000 105,000 140,000 175,000 210,000 Subtotal 1,751,688 2,182,180 2,428,374 2,645,687 2,803,158 2,991,955 Millions 1.75 2.18 2.43 2.65 2.80 2.99

Total

Option Item 1 2 3 4 5 6 Analysis 1,481,154 1,739,128 1,836,217 1,904,194 1,918,507 1,978,511 Sanitary inspection 11,190 15,491 19,079 20,559 22,621 31,554 Sampling 132,865 169,833 188,126 197,371 205,551 234,491 Laboratories 109,425 218,850 328,275 437,700 547,125 656,550 Transport 243,930 316,068 394,807 481,320 576,990 767,600 Subtotal 1,978,564 2,459,369 2,766,503 3,041,143 3,270,795 3,668,706 Millions 1.98 2.46 2.77 3.04 3.27 3.67

9.1 Sources of Funds

The following have been considered: National resources Money from the Public Treasury, from either the national or the regional budget. Donations Funds obtained from national or international agencies as non-repayable loans.

9.2 Use of the Funds

• Investments to implement laboratories − Central − Regional − Local.

• Investments for the operations of the Surveillance Program − Vehicle − Salaries and wages − Per diem

National Program for the Surveillance and Quality Control of Drinking Water 141

− Inputs − Replacement of equipment.

In the case of control by the suppliers, the cost will be assumed by the supplier and financed by the consumers through the water tariff.

9.3 Execution of the Surveillance Program

9.3.1 Institutional Scheme

The Program will be carried out by the Ministry of Health. The Ministry's Environmental Health Office will be responsible for coordination, administration and supervision at the national level, and its Regional Offices will be responsible at the regional level.

If the goals and objectives are to be met, it is imperative to promote the integrated and well-coordinated cooperation of all the institutions belonging to the sub-sector, such as the National Regulatory Agency and the Regional Regulatory Agencies, as well as the Association of Water Suppliers, in such a way as to optimize the effectiveness of efforts and human, material, and economic resources.

The proposal thus tends to facilitate the execution of the Program because it introduces an element of coordination between the surveillance agencies and the providers of water supply services. It is only logical that this coordination should be the task of the Health Authorities together with the National Regulatory Agency, so that all the efforts and resources involved can be channeled smoothly to accomplish the improvement of water services through the definition of goals. These goals target a reduction of the health risk and the prioritizing of investments for expansion and improvement of the water systems based on the data provided by the activities of surveillance and quality control of the water and the water supply services.

9.3.2 Process of Execution of the Program

The Program design, scheduling, planning of activities and assessment of services, should follow a dynamic ongoing process of planning, execution, assessment, and adjustment, which will cyclically lead to results increasingly closer to the ideal and the necessary.

Guidelines, methodologies, and lines of action will need to be established for the subsequent phases. This is the Health Authorities' job, and they will have to define in detail what should be done, how to do it, and what the desired results are. In this reference, the functions of the surveillance agency within the current public health system are indicated in Table 47. Table 48 summarizes the functions of the regional offices.

142 Guidelines for the Surveillance and Control of Drinking Water Quality

9.3.3. Expected Results of the Program

The activities of the Surveillance Program will make it possible to:

• Improve the levels of health and quality of life of The Country's population • Define: (a) The condition of the water supply services, (b) Shortcomings in the supply systems from the health-hazard point of view; and (c) Condition of services at the home level, in terms of physical components and proper water usage.

The first result will help the Water and Sanitation sector to set priorities for investments in extension of coverage and improvement of the existing systems.

The second group of results will call for close coordination to be established at the national and regional levels between the surveillance agency and the supplying agencies, so that realistic goals may be set to reduce the health risk of the water supply services. The investments contemplated in this reference should be defined by the Water and Sanitation sector taking account of priority criteria on which consensus has been reached by the water suppliers and the Ministry of Health.

Finally, the third result is associated with the planning of hygiene education activities for the population involving mass media campaigns on the proper use of water, care of the water installations in the home and, above all, improvement of the habits of hygiene and sanitary customs.

Taken together, these activities will contribute substantially to improving the health and quality of life of the population, as well as contributing to the country's social progress and development.

Table 47. Functions of the Sanitary Authority

a) Coordinate with the Regulatory Agencies and Sanitation Service Providers regarding the results of their drinking water quality control programs. b) Identify in each of the regions the communities where surveillance is to be carried out, so that the regions may plan their activities accordingly. c) Supervise compliance with the control and surveillance programs. d) Process the data on quality control provided by the suppliers. e) Periodically report on the situation of the quality of the water supply services. f) Perform follow-up on activities for the improvement of the quality of the drinking water and of the water supply services. g) Identify and quantify the needs for human, material, and economic resources for the surveillance work. h) Identify and formulate training requirements.

National Program for the Surveillance and Quality Control of Drinking Water 143

i) Periodically review current water supply standards and regulations. j) Start up the epidemiological surveillance program. k) Identify steps to be taken to introduce the environmental education program.

Table 48. Functions of the Regional Office for the Surveillance of Water Quality

a) Coordinate quality control activities with the local or regional institutions responsible for managing the water supply services. b) Register the different communities in its jurisdiction. c) Plan activities at the regional and local level; quantify investments and commit budget lines for the execution of the surveillance program. d) Perform the tasks included in the surveillance program (validation of sanitary inspections and water sampling and analysis). e) Process at the local level the data obtained in its jurisdiction. f) Notify the institutions responsible for the water supply systems about any observations arising from the surveillance work. g) Periodically report to the surveillance agency on the quality of the water and of the water supply services. h) Carry out the planned training, environmental education and community promotion activities.

9.4 Stages of Execution of the Program

Taking into consideration the socioeconomic conditions of the country, it has been decided to execute the Program in two stages. During a first three-year stage, the control programs being carried out by the Sanitation Service Providers in all the capitals of departments will be consolidated, the Ministry of Health reference laboratory and regional laboratories will be implemented, the Definitive Project broken down into departments and provinces will be concluded, and the required funding and material resources will be obtained. During the second seven-year stage, one of intense activity, the program will gradually expand to cover the whole country, beginning with small cities, followed by towns, and finally rural communities.

The stages will include the following actions:

a) First stage (three years)

• Institutionalization of the Program for the Surveillance of Drinking Water Supply Services. • Setting of goals for the training, environmental education, community, and epidemiological surveillance programs. • Strengthening of water quality control programs in large and medium cities.

144 Guidelines for the Surveillance and Control of Drinking Water Quality

• Planning of surveillance activities for application nationwide. • Introduction of surveillance work in the country's main cities. • Creation of database and information flow, notification, and internal control system. • Passing of the Law for the Surveillance of Drinking Water Services.

b) Second stage (seven years)

• Extension of the Program to cover the whole country.

9.4.1 Assessment and Control

Besides scheduling and execution, the Program management process includes assessment and control. The assessment and control processes will provide feedback on the planning, execution and administration of the surveillance activities. Assessment and control will be based on the policy lines and investments anticipated for the reduction of risk levels in the water supply systems, and will make it possible to adjust cyclically and in a well-coordinated manner the strategies, work policies, and regional and national programs under way.

Guidelines, methodologies, and lines of action will need to be established to serve as a work base for the subsequent phases. This is the Health Authorities' job, and they must define in detail what should be done, how to do it, and what results they hope to obtain.

The processes will be carried out continuously, fed by an efficient system of information at the regional and national level. In this way the scope of the Program will have to be continually adapted to the new conditions arising from the assessments and from the perfecting of the information system.

APPENDIX B

DRINKING WATER QUALITY CONTROL IN URBAN AREAS

CASE STUDY: SEDACUSCO WATER COMPANY CITY OF CUZCO, PERU

Drinking Water Quality Control in Urban Areas 147

CONTENTS

Page

1. Background...... 151 2. Introduction...... 151 3. Rationale ...... 152 4. Goals and Objectives ...... 153 4.1 Main Goal ...... 153 4.2 Specific Objectives ...... 153 5. Strategy ...... 153 6. Indicators ...... 154 6.1 Water Quality...... 154 6.2 Service Quality ...... 154 6.3 State of Repair of the Components of the Supply System...... 155

7. Methods and Procedures ...... 155 7.1 Prior Considerations ...... 155 7.2 Planning and Execution ...... 158 7.3 Quality Assurance of Data...... 159 Annexes Annex 1 Responsibilities...... 161 Annex 2 Sampling Parameters and Frequencies ...... 165 1. Introduction...... 167 2. Physical, Chemical and Bacteriological Requirements, and Sampling Frequency 167 3. Chlorine Residual ...... 167 Annex 3 Components of the Water Supply System ...... 169 Annex 4 Collection and Preservation of Samples ...... 175 1. Introduction...... 177 2. Containers and Volumes...... 178 3. Selection of Sampling Sites in the Network ...... 178 4. Sample Collection...... 181 5. Preservation ...... 183 6. Identification...... 184 7. Packing and Transportation ...... 185 8. Sampling Methods ...... 185 8.1 Sampling from Faucets ...... 185 8.2 Sampling in Open Wells or Storage Reservoirs...... 186 Annex 5 Training Program...... 189 Annex 6 Supply Areas ...... 193

148 Guidelines for the Surveillance and Control of Drinking Water Quality

Annex 7 Number of Samples...... 197 1. Scope...... 199 2. Number and Frequency of Samples...... 199 3. Cost...... 201 Annex 8 Data Collection Forms...... 203 Annex 9 Quality Assurance of Data ...... 207 1. Introduction...... 209 2. Number of Evaluations Conducted (1) ...... 209 3. Consistency of the Results (2) ...... 209 4. Number of Direct Supervisions (3)...... 210 5. Number of Verifications Conducted in the Field (4) ...... 210 6. Quality of Field Work (5) ...... 210 List of Tables Annex 2 Table 1 Analytical Determinations and Number of Samples per Year...... 167 Table 2 Determination of Chlorine Residual ...... 167 Annex 3 Table 1 Treatment Plants ...... 171 Table 2 Surface Sources...... 171 Table 3 Ground Sources. Wells ...... 171 Table 4 Ground Sources. Filtration Galleries ...... 171 Table 5 Ground Sources. Springs ...... 171 Table 6 Components. Storage Reservoirs...... 171 Table 7 Components. Distribution Reservoirs ...... 172 Table 8 Components. Pump Stations ...... 173 Table 9 Components. Cisterns ...... 173 Table 10 Components. Pressure Relief Boxes...... 173 Annex 4 Table 1 Containers and Type of Preservatives by Group of Determinations ...... 183 Table 2 Form for Water Sample Collection and Assessment of Service Quality Distribution Network ...... 184 Annex 6 Table 1 Characteristics of the Supply Areas...... 195 Annex 7 Table 1 Number of Analytical Determinations per Year, SEDACUSCO ...... 200 Table 2 Number of Chlorine Residual Determinations per Year, SEDACUSCO...... 200 Table 3 Cost of Analytical Determinations...... 201 Annex 8 Table 1 Distribution Network ...... 205 Table 2 Components ...... 206 Table 3 Treatment Plant...... 206

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Annex 9 Form E-1 Quality Assurance of Data...... 212

List of Figures

Figure 1 Sampling Sites in Open Distribution ...... 179 Figure 2 Sampling Sites in Closed Distribution System...... 180 Figure 3 Sampling Sites in Mixed Distribution Systems ...... 180

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1. Background

Before the 1991 cholera outbreak in Peru, most countries in Latin America and the Caribbean concentrated on the quantity rather than the quality of water. Today, the authorities are more concerned with improving the quality of drinking water, and they are paying greater attention to surveillance and control. Many countries have been motivated to execute programs for the surveillance and quality control of drinking water as part of their environmental health measures to prevent the transmission of gastrointestinal diseases.

Drinking water quality has a strong impact on people’s health because water is a vehicle of transmission for many microorganisms of gastrointestinal origin, pathogenous to human beings. Among the more representative pathogenous agents which may be present in drinking water, we have bacteria, viruses, and to a lesser extent, protozoa and helminths. These microorganisms differ widely in size, structure, and constitution, which explains why their survival in the environment, as well as their resistance to treatment processes, also differ significantly.

Another factor of great importance is the conservation of the quality of water in the distribution system. This factor is linked with: a) state of conservation of the physical infrastructure of the distribution network; b) management of the system; and c) handling of water in the home. At this point we should also mention quantity, continuity, coverage, and cost: taken as a whole, these indicators make it possible to determine the quality of the water supply system and identify its service level.

2. Introduction

Water for human consumption has been defined in the World Health Organization (WHO) Guidelines for Drinking Water Quality as that water which is “suitable for human consumption and for all normal domestic purposes, including personal hygiene.” Implicit in this definition is the principle that the use of this water should not present any kind of health risk such as chemical irritation, intoxication, or microbiological infection harmful to human health.

The microbiological quality of drinking water is of a great primary importance, and the monitoring of bacterial indicators such as total coliforms and thermotolerant coliforms should be given the highest priority. Chemical pollution is also very important, but it is not associated with acute effects on human health, and has a lower short-term priority than bacteriological contamination, often becoming irrelevant in areas where water-related microbiological and parasitic diseases are strongly prevalent.

152 Guidelines for the Surveillance and Control of Drinking Water Quality

and during the laying of new pipes or repair work carried out without safety measures. Another recontamination factor, significant in developing countries where there is a shortage of water, is the interruption of the supply as a result of rotation of service from one supply area to another.

In low-reliability systems, the constant interruption of the water supply system leads to the deterioration of the physical, chemical, and especially the microbiological quality of water in the consumers’ homes, because of inadequate handling and storage.

The concepts and procedures set forth in this document are based on the Guidelines for Drinking Water Quality developed by the Pan American Center for Sanitary Engineering and Environmental Sciences (OPS/CEPIS), with the financial support of the U.S. Environmental Protection Agency (EPA) (see Part I of this document). With a view to validating the methodology in an urban environment, CEPIS came to an agreement with the water supply agency of Cuzco (SEDACUSCO) for the implementation of a pilot project on drinking water quality control in the city of Cuzco.

The methodology for urban areas has been designed to determine the sanitary condition of the water supply services by evaluating the quality of the drinking water and the sanitary condition of the components of the water supply system, which together will make it possible to define the service level provided by SEDACUSCO.

3. Rationale

Water supply systems should be designed, operated and maintained in such a way as to preserve and conserve drinking water quality. However, it is not unusual to find fortuitous situations caused by poor conditions of the infrastructure, which affect the quality of drinking water. Defects and shortcomings in the infrastructure may be the result of bad design, bad construction (or careless construction supervision), or poor maintenance. They may also be caused by natural or human factors, such as earthquakes or social disruptions, which render the structures of the water supply system unable to protect and maintain the drinking water quality.

The community’s attitude toward the water supply system is more passive in an urban environment than in rural areas. This is because their water supply service is managed by a water supply agency, supervised by the regulatory agency, and monitored by the Ministry of Health, as well as being subject to supervision by civil organizations.

Moreover, the water supply agencies are staffed with professionals duly trained in the areas of management, operations, and maintenance, all of whom do their best to deliver a good water supply service in exchange for the payment of an established tariff. The consumers are normally able to afford this tariff, which is used to pay staff and to purchase the supplies required to operate and maintain the water supply system efficiently.

The quality or level of the supply service is another factor of great importance for the improvement of the beneficiary population’s health. Ideally, the whole community should be

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served efficiently and effectively. However, it is often the case that the water supply service has limited coverage and/or very low continuity. This means that sectors of the population have to store their water to cover their basic needs, which results in the deterioration of the water quality and the consequent exposure of consumers to communicable water-related diseases.

4. Goals and Objectives

4.1 Main Goal

To establish the bases for implementation by SEDACUSCO of a drinking water quality control program, which will determine the quality of water for human consumption in the city of Cuzco.

4.2 Specific Objectives

a) Determine the quality of the drinking water; b) define the degree of deficiencies in the components of the water supply systems; c) identify corrective measures; d) plan investments.

5. Strategy

The objectives will be reached as follows:

• The quality of drinking water in the distribution system will be determined by physical, chemical, and bacteriological evaluation of the water, from the catchment to the beginning of the home connection. To this effect, three groups of evaluation sites will be established: a) outlets from treatment plants, which may be represented by the feeder mains or storage reservoir; b) components such as distribution reservoirs and tanks; and c) the distribution network.

• The condition and degree of conservation of the water supply infrastructure will be evaluated by direct inspection of the main system components, to identify any defects that may affect the conservation of the drinking water quality.

• Identification and prioritization of remedial measures will be accomplished with the assistance of computer software which will process data on water quality in each of the supply areas, and data on the sanitary condition of the main components of the water supply system.

The following is the information required for planning the control activities: a) inventory of the components of the water supply system, b) identification of water supply areas, c) acceptable parameters and limits, d) findings of water sample analyses, and e) sanitary inspection.

154 Guidelines for the Surveillance and Control of Drinking Water Quality

The quality control department will be responsible for planning. To this effect, it must have access to information concerning the physical, operational, and maintenance parts of the water supply system. With this information, it will proceed to locate the components and supply areas, taking into account the influence of supply sources and components, especially storage reservoirs, wells, pressure-relief chambers, etc., linking them to the population of users. Fixed and random sampling sites will be established, taking existing recommendations into consideration. The sampling program will be developed on the basis of sampling frequency and obligatory parameters for each type of structure.

Planning, sampling, on-site testing, and sanitary inspections are the responsibility of the quality control department; while physical, chemical, and bacteriological analyses will be conducted by the SEDACUSCO central laboratory. Data processing and the drafting of annual and other periodic reports, as well as follow-up of the implementation of corrective measures, will also be the responsibility of the quality control department.

6. Indicators

Corresponding to the objectives indicated above, the result indicators which will be obtained from the water quality control program are: a) water quality; b) continuity and pressure (service level); and c) state of conservation of the components of the water supply system.

6.1 Water Quality

Water distributed through the supply systems should be innocuous. This implies that the water quality must comply with the physical, chemical, and bacteriological standards set down by the health authorities, to ensure that the water will not be harmful to consumers’ health.

In the specific case of SEDACUSCO, the analytical parameters have been established by the regulatory agency, SUNASS (National Superintendence of Water and Sanitation), based on the analytical capacity of the SEDACUSCO laboratory. These parameters have been grouped according to the main parts of the water supply system, such as a) outlet from surface sources; b) outlet from underground sources; c) outlet from reservoirs; and d) distribution network.

6.2 Service Quality

Water supply systems must comply with the minimum requirements for which they were conceived and built. These minimum requirements are synthesized in satisfying the basic water supply needs of the community, within the concept of quality and its link to the preservation and conservation of the consumers’ health.

For this project, we have considered that the service level can be assessed by determining the functional characteristics of the water supply system, such as a) continuity of the water supply; and b) water pressure.

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6.3 State of Repair of the Components of the Supply System

Conservation of the quality of drinking water is dependent on the absence of physical defects in the components which make up the water supply system; as well as the availability of protective elements for the conservation of the water’s physical, chemical, and bacteriological characteristics.

Observation of the condition and state of repair of the infrastructure is accomplished by sanitary inspection. The objective of the inspection is to identify possible defects in the components of the water supply system, and in the operational and maintenance practices which may imply risks for the conservation of the drinking water quality.

The information provided or obtained in the course of the sanitary inspection work will make it possible to identify the measures required to correct any defects which may have been detected (associated with construction, operation, maintenance, or any other deviation from accepted standards of normal practice), in order to minimize the risk of contamination of water intended for human consumption.

7. Methods and Procedures

7.1 Prior Considerations

Prior to the initiation of a water quality control program by SEDACUSCO, a clear definition was needed of the responsibilities of the quality control unit and of the relationship of this unit to the other offices of the water supply company. It has been decided, in principle, that the quality control unit should report directly to General Management and receive the support of the water-testing laboratory at the Santa Ana plant.

This independence will imply the need to appoint the required staff and to provide furniture, office equipment, and appropriate means of transportation. In addition, and from an entrepreneurial standpoint, the quality control unit should be given the support of the operations area for sampling and chlorine residual testing in reservoirs, re-pumping stations, and treatment plants.

The laboratory, based on the number of samples to be tested, will need to determine its requirements with regard to equipment and chemical supplies, prepare testing procedure manuals, and implement the analytical quality control program.

The quality control office, for its part, should schedule control activities and train sampling staff. It will also be important to set up a quality assurance program to monitor the information gathered during the sampling process and sanitary inspections.

a) Responsibilities: It is understood that the quality control of drinking water is a corporative task, shared by all offices of SEDACUSCO, with the quality control office at

156 Guidelines for the Surveillance and Control of Drinking Water Quality

their head. However, internal guidelines will need to be issued to specify the functions and responsibilities of each of the participants in the planned control program (see Annex 1).

b) Basic equipment: The Quality Control Office will have the minimum facilities necessary to execute the water quality control program in the city of Cuzco. Minimum facilities include physical space and equipment (desks, computers, etc.).

c) Laboratories: The Santa Ana laboratory has the necessary consumables and supplies for performing water quality control, such as physical space, furniture, equipment, instruments, glassware, chemicals for physico-chemical testing, culture media for bacteriological tests, among others.

d) Water quality criteria: The regulatory agency has established, for the city of Cuzco, the parameters to be analyzed and the sampling frequency, including the determination of chlorine residual at different sites: treatment plants, components, and distribution network (see Annex 2). In the case of the samples to be taken from the distribution network, it has been decided that the network will de divided into sectors based on supply areas, and that this sectorization will be in accordance with a) the hydraulic areas of the distribution network; b) the supply source; c) the influence of the system components; d) water pressure, and e) the fact that each supply area should cover no more than 20,000 inhabitants.

Sporadic determination of chlorine residual and thermotolerant coliforms has also been considered for household installations, to assess the degree of conservation of quality inside the home. Another decision agreed on is that the chlorine residual and pH testing should be performed during sampling, while the other analyses will be conducted at the SEDACUSCO laboratory.

e) Basic information: The information required for the planning of quality control activities consists mainly of: the definition of the characteristics of each of the components of the water supply system, the configuration of the water supply system, and the geographical limits of the hydraulic sectors of the city of Cuzco. Annex 3 lists the characteristics of each of the components of the supply system, and a diagram of the location and limits of the eleven hydraulic sectors.

f) Manuals for sample collection and on-site analyses: The sampling must be carried out by trained staff to ensure that the water samples are representative of the supply system and that they will not be contaminated during the sampling and transportation processes. To that end, staff must be trained to comply strictly with the procedures of sampling, preservation, packing and transportation of samples to the laboratory. They must also be trained to determine on site the free chlorine content, pH and certain other types of information relative to the supply system. The staff in charge of this work must therefore be exclusive and enjoy the absolute trust of the quality control office.

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The sampling sites will be:

• Outlets from groundwater sources such as springs and water wells; • outlets from water treatment plants; • outlets from components (storage or distribution tanks pressure-relief chambers, etc.); • pumplines and feeder mains; • distribution network. The sampling points must be evenly spread throughout the distribution system and be proportional to the number of users, taking into account: - sites of social responsibility such as: health centers, schools, places of mass food preparation, public standpipes. - dead points, low pressure points or restricted supply points.

Annex 4 describes the method for the collection and preservation of samples and the special care to be taken in sample collection. g) Laboratory analyses: With regard to the analyses to be carried out by the Santa Ana Plant laboratory, it is recommended that they follow universally accepted procedures, in order to guarantee the results of the analyses and render them comparable. The Standard Methods for the Examination of Water and Wastewater of the American Public Health Association (APHA), the American Water Works Association (AWWA) and the Water Environment Federation (WEF) (1995) has therefore been adopted. h) Training: The training program must involve all tiers of the organization connected with the control program, paying special attention to the formation of the staff responsible for field activities and data processing.

The quality of the information produced by the quality control unit depends on the work carried out by the staff responsible for collecting samples, conducting sanitary inspections, performing analyses, processing information, etc. For this reason the staff must be trained to do their work to a high standard. A good training program will ensure that the data and their processing will be standardized and comparable among the different generators of information, thereby facilitating systemization at the regional and national level. The training should be designed to prepare personnel in:

• Planning the task; • identifying the characteristics of the water supply services; • evaluation of components and identification of sanitary risks; • collection and preservation of samples; • field analyses; • microbiological, physical and chemical analyses; • processing of information; • interpreting and reporting results.

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Collecting information on the physical characteristics of the water supply systems, handling the forms, taking samples and performing field analyses require specific training, which must be both theoretical and practical.

Annex 5 contains a model training program for staff in charge of field activities.

7.2 Planning and Execution

The activities involved in the quality control work for urban water supply services are:

a) Planning: —Before beginning its control work, the quality control office must obtain general information about the characteristics of the water supply system, from supply sources to the secondary distribution network, considering all components, as well as total population and number of users, public establishments— especially those relating to education and health, and high-density areas, service level, etc. These data will help it identify all the factors that might affect the water quality, and will facilitate the planning of control activities.

In addition, planning should include the definition of:

• Sampling frequency and number of analytical determinations required. • Frequency of sanitary inspections. • Sampling and analysis procedures. • Accessibility. • Establishments that form part of the information flow. • Preparation of the database.

Annex 6 lists the supply areas into which the city of Cuzco has been divided. The division was made based on hydraulic sectors, and taking into consideration the characteristics of the supply system; for example, supply source, components which provide direct or indirect services, total population and user population, among others. Annex 7 shows the number of samples to be collected throughout the city during the present year.

b) Execution: After planning the different activities involved, the quality control unit can proceed with the control program. The following tasks have been defined: a) gathering information; b) sampling and testing; c) analyzing information; d) identifying corrective measures; and e) reporting. See Annex 8 for models of the forms used for gathering data relevant to the treatment plants, reservoirs, distribution network, and sanitary inspections.

c) Analysis of the information: The analysis of the information will permit the rating of three basic aspects: a) drinking water quality; b) service level; and c) condition of the infrastructure.

With reference to water quality, it will be classified in groups according to its origin, thus considering: a) outlet from water treatment plant or from underground sources, only with

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regard to the quality of drinking water supplied to the population, but excluding the quality of raw water; b) outlet from intake structures such as storage reservoirs, distribution reservoirs, and tanks; and c) distribution networks, both primary and secondary. Only in very special cases will water samples be collected in consumers’ homes, since SEDACUSCO’s responsibility does not exceed property limits.

d) Corrective measures: After processing the information from the field and the laboratory, it will be possible to identify the main problems in the water supply system that has been evaluated.

7.3 Quality Assurance of Data

The data obtained by the staff responsible for the water quality control work should be subject to validation to ensure accuracy. The performance of the persons responsible for field work is evaluated on the following five points:

Number of evaluations conducted Consistency of the results Number of direct supervisions Number of verifications in the field Quality of field work

See Annex 9 for the procedure to be carried out in assuring the quality of the data.

ANNEX 1

RESPONSIBILITIES

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Different agents are involved in the process of controlling the quality of drinking water. Among these, we can mention operational and laboratory staff, and the staff of the control offices.

The responsibilities of each one of them are listed below:

Control office: In this office, several levels have been defined: a) planners; b) data-entry clerks; c) inspector–samplers; d) supervisors; and e) drivers.

Planners are responsible for defining the scope of the monitoring program, outlining the strategies to comply with the regulatory agency’s requirements, and planning field work, that is, fixing dates and sites for sample collection. In addition, and with the help of SEDACUSCO programmers, they will shape the program based on what has been planned, and assess the reliability of the data obtained by the samplers and inspectors. They should periodically process the data and report to the pertinent levels on the results of their work.

Data-entry clerks are responsible for entering into the data-base all the data from sample collection, sanitary inspections, and the findings of chlorine residual analyses conducted in treatment plants, reservoirs, and the distribution networks.

Inspector-samplers are responsible for conducting sanitary inspections of the different components of the water supply system; collecting water samples from treatment plants, reservoirs, and the distribution network; filling out sample forms; conducting field tests, preserving samples, packing them properly so that they will not become contaminated during transportation, and taking them to the laboratory; and, finally, reporting the results of their work to the pertinent levels.

Supervisors are responsible for verifying that the data provided by inspector-samplers are accurate. To this effect, they will validate through random sampling part of the information supplied by the staff responsible for inspection of the sampling.

Drivers are responsible for the transportation of the staff engaged in water quality control.

Laboratory: Responsible for conducting the analytical determinations specified in the sample delivery form, applying analytical quality control procedures to guarantee the quality of the data. In addition, in the event of suspicious results, the laboratory should report these immediately to the quality control office, so that the latter may proceed to collect new water samples, and, if necessary, adopt measures to prevent the spreading of any micro-organism or toxic substance that may affect the health of the consumers.

Operational control: The responsibility of this office is to provide support in the determination of chlorine residual at the outlets from treatment plants and reservoirs. In addition, it implements the necessary remedial measures if there are reports of problems in the quality of the city’s water supply.

ANNEX 2

SAMPLING PARAMETERS AND FREQUENCIES

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1. Introduction

For the Drinking Water Quality Control Program to be implemented in the city of Cuzco, the regulatory agency has selected a set of parameters to evaluate the quality of the drinking water.

2. Physical, Chemical, and Bacteriological Requirements, and Sampling Frequency

Table 1 shows the determinations to be performed by the Quality Control Program.

Table 1. Analytical Determinations and Number of Samples per Year

Determinations Outlet from sources Distribution Reservoirs Ground Surface network Total coliforms 4 52 12 12 Thermotolerant coliforms 4 52 12 12 Turbidity 4 365 12 52 PH 4 365 12 26 Conductivity 4 365 12 26 Total hardness 1 4 4 2 Chlorides 1 4 4 2 Sulfates 1 4 4 2 Nitrate 1 4 4 2 Color 1 4 4 2 Iron 1 4 4 2 Manganese 1 4 4 2 Aluminum 0 12 0 2

3. Chlorine Residual

Testing for the presence of chlorine residual is not an indispensable requirement for the assessment of drinking water quality. However, its determination is considered a decisive element in the conservation of the bacteriological quality of the water. To this effect, the determination of chlorine residual should be carried out in different parts of the supply system as indicated in Table 2.

Table 2. Determination of Chlorine Residual

Parts of the system Location Frequency Components Outlet from plants Every 6 hours Reservoirs larger than 4.000 m3 Every 6 hours Reservoirs smaller than 4.000 m3 Once daily Distribution network Supply area Once daily

ANNEX 3

COMPONENTS OF THE WATER SUPPLY SYSTEM

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INVENTORY AND CHARACTERISTICS OF THE WATER SUPPLY SYSTEM OF THE CITY OF CUZCO

Input Information. Water Supply System

Table 1. Treatment Plants Name Control Code SEDACUSCO Location Source of Treatment Code supply capacity (m3/d) Santa Ana PTA-001 INPLT0001 Av. Humberto Vidal Unda 421 Piuray lagoon and 26,956.8 springs* Jaquira PTA-002 INPLT0002 APV Los Jardines Jaquira springs and 777.6 surface waters ** * Springs: Fortaleza Nueva, Chaullamarca, Cuncunyac, Ñahuimpugio. ** Springs: Fortaleza Nueva, Chaullamarca, Cuncunyac, Ñahuimpugio.

Table 2. Surface Sources Name Control Code SEDACUSCO Location Catchment capacity Code (m3/d) Piuray lagoon FS-001

Table 3. Ground Sources. Wells Name Control Code SEDACUSCO Location Working Volume Depth Pumping power Code condition (m3/d) (m) (hp) Well 1 PZ-001 FS01 Piñipampa Good 9,158.4 65 160 Well 2 PZ-002 FS02 Piñipampa Good 9,158.4 65 160 Well 3 PZ-003 FS03 Piñipampa Good 9,158.4 65 160 Well 4 PZ-004 FS04 Piñipampa Good 9,158.4 65 160

Table 4. Ground Sources. Filtration Galleries Name Control Code SEDACUSCO Location Working Production flow Code condition (m3/d) Salkantay GA-001 GA01 Salkantay Good 2,008.8

Table 5. Ground Sources. Springs Name Control Code SEDACUSCO Location Working Production flow Code condition (m3/d) Kor Kor* MN-002 REDIS0002 Kor Kor Good 7,715.52 Jaquira MN-003 INRLT0003 Jaquira Good 10,00512 * Chaullamarca and Fortaleza Nueva.

Table 6. Components. Storage Reservoirs Name Control SEDACUSCO Location Working Storage capacity Code Code condition (m3) Santa Ana R-3 R-003 INRES0003 Av. Humberto Vidal Unda 421 Good 6,500 Picol Larapa R-012 INRES0012 Larapa Grande Good 4,500 R-12 Jaquira R-039 INRES0039 Jaquira Good 300 El Arco R-032 INRES0032 Good 400 Tambillo R-017 INRES0017 Tambillo Good 1,000

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Table 7. Components. Distribution Reservoirs

Name Control SEDACUSCO Location Type Working Storage Code Code condition capacity (m3) Los Andenes R-1 R-001 INRES0001 Jn. Antisuyo 420, Los Circular – Good 1,800 Andenes Reinforced concrete Puquin R-2 R-002 INRES0002 Puquín Circular – Good 455 Reinforced concrete Picchu R-4 R-004 INRES0004 Av. Túpac Amaru 422, Rectangular – Good 3,400 cuadra 01 Reinforced concrete Qoripata R-5 R-005 INRES0005 Fortunato Herrera s/n, Square – Good 2,100 Santiago Reinforced concrete Mcal. Gamarra IE R-007 INRES0007 Mcal. Gamarra Rectangular – Good 120 R-7 Reinforced concrete Mcal. Gamarra IIE R-008 INRES0008 Cruzpata Circular – Good 250 R-8 Reinforced concrete Campiña Baja R- R-010 INRES0010 Campiña Baja Circular – Good 3,000 10 Metal Wimpillay R-13 R-013 INRES0013 Wimpillay s/n, Santiago Circular – Good 1,500 Metal Ununchis R-42 R-042 INRES0042 Urb. Santa Rosa s/n, San Circular – Good 500 Sebastián Reinforced concrete Independencia R- R-035 INRES0035 APV Independencia Circular – Good 150 35 Reinforced concrete Villa María R-33 R-033 INRES0033 Villa María Circular – Good 150 Reinforced concrete Small reservoirs Mosocllacta R-19 R-019 INRES0019 Av. Circunvalación Rectangular – Good 25 Reinforced concrete Alto Balconcillo R- R-020 INRES0020 APV Balconcillo Circular Good 35 20 Bajo Balconcillo R-021 INRES0021 APV Balconcillo Circular Good 36 R-21 Sétima Cuadra R- R-022 INRES0022 APV Lucrepata Rectangular – Good 50 22 Reinforced concrete Ucchullo Alto R- R-023 INRES0023 APV Cristo Pobre Rectangular – Good 70 23 Reinforced concrete Los Licenciados R- R-025 INRES0025 San Sebastián Licenciados Circular Good 75 25 Buena Vista R-29 R-029 INRES0029 Buena Vista Circular – Good 85 Reinforced concrete Atocsaycuchi R-046 Huarapunku R-047 Larapa R-048

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Table 8. Components. Pump Stations

Name Control SEDACUSCO Location Working Pump Pumping power Code Code condition flow (hp) (m3/d) Rumicolca EB-002 EB2 Rumicolca Good Qollana EB-003 EB3 Qollana Good

Table 9. Components. Cisterns

Name Control SEDACUSCO Location Working Storage capacity Code Code condition (m3) Rumicolca CT-002 Rumicolca Good Qollana CT-003 Qollana Good

Table 10. Components. Pressure Relief Boxes

Name Control Code SEDACUSCO Location Working Diameter Code condition (mm) Zárate RP-001 RP001 Zárate Good 4” Tetecaca RP-002 RP002 Tetecaca Good 4” cast iron Amargura RP-003 RP003 Amargura Good 8” cast iron Puntop C RP-004 RP004 Ttio, fifth stop Good 12” cast iron Pucllasunchis RP-005 RP005 Pucllasunchis Good 3” cast iron Santa Ana RP-006 RP006 Santa Ana Good 14” cast iron Karigrande RP-007 RP007 Karigrande Good 12” cast iron Bolivar RP-008 RP008 San Sebastián, third stop Good

ANNEX 4

COLLECTION AND PRESERVATION OF SAMPLES

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1. Introduction

One of the main components of the Drinking Water Quality Control Program is the evaluation and characterization of the water supplied to the people. Evaluation and characterization of the water are carried out by analyzing the water samples obtained from the supply system.

This Section is concerned with different aspects of the sampling process, and the special care that must be taken from the time the sample is collected up to its arrival at the laboratory.

Care must be taken during the collection and transportation of samples to ensure that the water sample does not become contaminated at these stages. The following requirements must also be met:

Sampling Sites Select the sampling sites so that the samples obtained will be representative of the water flowing through the supply system.

Taking the Sample Take an adequate volume of the sample in flasks appropriate for the laboratory.

Preservation Protect the water sample from any significant change in its composition before its analysis.

Identification Clearly record the details of the sampling on the cards accompanying the flasks with the water samples.

Packing and transportation Pack the water samples properly to avoid breakage of the containers or contamination of the contents, and send them to the laboratory as soon as possible for analysis.

The Drinking Water Quality Control Program includes field testing for free residual chlorine, and eventually, determination of turbidity and pH.

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2. Containers and Volumes

When taking water samples for analysis, care must be taken in a number of aspects, according to the type of sample.

a) Bacteriological The bottle, jar or flask for taking bacteriological samples must be sterilizable, preferably of glass, with a wide mouth, a securely closing cap or stopper and capacity of no less than 120 milliliters.

b) Physical The sample containers used in this group of analyses can be plastic (polyethylene or polypropylene) or glass, of half-liter capacity, carefully washed with detergent and rinsed with abundant water.

c) Chemical The sample containers used in this analysis group can be plastic (polyethylene or polypropylene) or glass, of one-liter capacity. The washing procedure is similar to the previous one, except that the cleaning with hydrochloric acid must be even more thorough.

3. Selection of Sampling Sites in the Network

The objective of the sampling is to determine the “quality of the water in the supply system,” whether it be in the components or the user’s faucet or at some other outlet of water destined for human consumption.

The sampling points selected in the distribution network must therefore be such as to ensure that the samples are representative of the existing water supply; points inside homes that have private storage should be discarded. The general criteria to keep in mind in selecting the sampling points are that they must:

a) Be representative of the supply system as a whole and its principal components. b) Represent the quality of the different sources of water supply. The sampling points should be located immediately outside the outlet from the treatment plant or water well. c) Represent the conditions of the least favorable places in the system from the point of view of possible contamination. d) Be spread evenly throughout the length and breadth of the water supply system. e) Consider the presence of the different components (storage tanks and/or pumping chambers). f) Take into account the number of inhabitants served by the supply system.

Drinking Water Quality Control in Urban Areas 179

In addition, the sampling points are selected according to the type of distribution system, which could be open, closed or mixed.

a) In open distribution systems, the most representative sampling points are those shown in Figure 1. b) Likewise, in closed distribution systems the sampling points to be emphasized are those shown in Figure 2. c) Finally, in mixed distribution systems the sampling points are selected as shown in Figure 3.

In addition, the following aspects must be considered:

1. Critical points of the system such as areas with old networks, areas with a history of continual breakage, areas with low pressure, or areas exposed to frequent flooding. 2. Areas with a high population density. 3. Supply points for tank trucks and individual collection. 4. Food industry areas. 5. Emergency areas. 6. Areas used for recreation or mass meetings.

Figure 1. Sampling Sites in Open Distribution

(a) At the outlet of the water treatment plant. Indicates the quality of the water entering the distribution system. (b) At an intermediate point, to be representative of the water in the mains. (c) At one or more points that are representative of the water at the ends of the distribution network.

180 Guidelines for the Surveillance and Control of Drinking Water Quality

Figure 2. Sampling Sites in Closed Distribution Systems

(a) At the outlet of the water treatment plant. Indicates the quality of the water entering the distribution system. (b) At a point representative of the water in the main circuit. (c) At points that are representative of the water in the secondary circuits or at the end of the water distribution network.

Figure 3. Sampling Sites in Mixed Distribution Systems

(a) At the outlet of the treatment plant and/or water wells. Indicates the quality of water entering the distribution system. (b) At the outlet of the storage components. (c) At points representative of the water in the main circuit. (d) At points representative of the water in the secondary circuits or at the end of the water distribution system.

Drinking Water Quality Control in Urban Areas 181

4. Sample Collection

General

The collecting or taking of a sample depends on the types of structures or sampling points. These can be classified as follows: Components Reservoirs Feeder mains or pumplines Cisterns Distribution network

Samples are collected in the distribution network from home connections linked directly to the distribution network, public standpipes, or pressure relief valves, or any other element within the distribution network itself.

Procedures

Precautions are taken in keeping with the type of analysis. The procedures can therefore be described as follows:

Bacteriological

a.1 Components (reservoirs and cisterns)

Cleaning Remove any type of residual found around the lid of the component with a brush.

Removal of the Lid Remove the lid carefully, taking care that no type of residual falls into the component.

Opening of the Sterilized Flask Untie the string that holds the protecting paper sleeve in place, remove the sleeve and unscrew the top.

Sterilization Using a flame lit on a wad of absorbent cotton soaked in alcohol, sterilize the external part of the sample flask.

Taking of the Sample After the flask has cooled, very carefully submerge it in the mass of water, to a depth of approximately 20 centimeters.

182 Guidelines for the Surveillance and Control of Drinking Water Quality

Replacing the Stopper Before replacing the stopper, pour off a small amount of water to leave an air space which will facilitate sample shaking (mixing) at the analysis stage.

Then replace the stopper on the flask and cover with the protecting kraft paper sleeve. Tie this in place with the string.

a.2 Distribution Network (home connections, public standpipes, pressure-reducing valves) Cleaning the Faucet Remove from the faucet any material adhering to it that could cause splashing. Carefully clean the mouth of the faucet with a clean cloth to remove any dirt or grease.

Washing out the Faucet Open the faucet to its maximum flow and let the water run for 1-2 minutes.

Sterilization Before taking the water sample, close the faucet and sterilize it for one minute with the flame from a piece of absorbent cotton soaked in alcohol. As an alternative, a gas flame or a lighter can be used.

Draining the Faucet before Sampling Open the faucet carefully and allow the water to flow slowly for 1-2 minutes more, at a speed suitable for filling the sample flask easily.

Opening the Sterilized Flask Untie the string that is holding the protecting paper sleeve in place, and remove the paper sleeve.

Taking the Sample Remove the stopper or unscrew the cap and, while holding it in one hand, immediately put the flask under the flow of water and fill it. Leave a small air space to facilitate shaking at the analysis stage.

Sealing the Flask Replace the stopper on the flask or screw on the cap. Tie the protecting paper sleeve in place with the string.

Chemical

In these specific cases, the same care must be taken during the sampling as that indicated for the bacteriological analyses.

Drinking Water Quality Control in Urban Areas 183

The only exception is in the rinsing of the sample bottles during the sampling process, which should be carried out two consecutive times before taking the final sample. Once the sample has been collected, and depending on the type of analysis to be performed, the appropriate preservative is added.

5. Preservation

It is impossible to recommend the exact time between sample collection and analysis. However, the following general points should be taken into account.

Bacteriological In the case of samples of drinking water suspected of being slightly contaminated and without any type of preservation (refrigeration) it is acceptable for up to two hours to elapse between the sampling and the beginning of the analysis. Refrigerated samples should be analyzed no later than 24 hours after being taken.

Chemical This group of analyses should be divided into two parts. The first group includes chlorides, total hardness, sulfates, nitrate, pH, conductivity, and turbidity, which require only refrigeration and a period of up to seven days between sampling and testing.

The second group is represented by aluminum, iron, and manganese. For the preservation of these samples, it is necessary to add 5 milliliters of concentrated nitric acid per liter of sample. The time between collection and testing can be up to three months. Table 1 presents the types of preservatives to be used in the conservation of water samples.

Table 1. Containers and Type of Preservatives by Group of Determinations Type of Container Determination Preservative and Volume (*) Bacteriological Total coliforms G 120 mL Refrigeration at 4 °C Thermotolerant coliforms Physical Color Turbidity P, G 500 mL Refrigeration at 4 °C PH Conductivity Chemical non-metallic Total hardness Nitrate P, G 500 mL Refrigeration at 4 °C Chlorides Sulfates Chemical metallic Aluminum Iron P, G 1000 mL Nitric acid 5 mL Manganese (*) G = Glass P = Plastic

184 Guidelines for the Surveillance and Control of Drinking Water Quality

6. Identification

Once the water sample has been collected, the sample identification tag should be properly filled in with all the required data.

Table 2 shows models of the forms to be applied in this quality control program.

Table 2. Form for Water Sample Collection and Assessment of Service Quality Distribution Network

Sample number Supply area Date District Address Time Sampling Site Continuity Fixed Hours per day Random Days per week Sampling Point Determinations Home Coliforms School Turbidity Public office pH/Conductivity Shop or store Physico-chemical Food industry Aluminum Miscellaneous industries Chlorine residual Public network Type of Sample Pressure First Pressure Confirmation Sampler Components Sample number Code Date Time Determinations Sampling Point Coliforms Storage reservoir Turb./pH/Conduc. Distribution reservoir Physico-chemical Small reservoir Aluminum Pump station Chlorine residual Cistern Type of Sample Pressure-relief First Well Confirmation Gallery SAMPLER Spring Source/treatment plant Sample number Code Date Time Determinations Sampling Point Coliforms Storage reservoir Turb./pH/Conduc Feeder pipe Physico-chemical Source Aluminum Surface Chlorine residual Ground Type of sample Sampler First Confirmation

Drinking Water Quality Control in Urban Areas 185

7. Packing and Transportation

The samples sent to the regional laboratory or central laboratory should be adequately packed in strong cases.

The bottles or flasks should be accommodated in the packing cases in such a way as to make it unlikely that they will knock against each other and break. In the event that they need to be refrigerated, this aspect must be taken into account, since extra space will need to be provided for the coolant mixes or the ice.

8. Sampling Methods

8.1. Sampling from Faucets

a) Remove any foreign matter from the faucet, such as pieces of hose or other objects. Make sure that there are no leaks in the faucet seals or washers. If leaks are detected, they must be repaired before sampling for a bacteriological test. Otherwise, select another sampling point.

b) Open the faucet and let the water flow for one to two minutes, before collecting the sample. This procedure cleanses the opening and flushes out water which has collected in the pipe.

186 Guidelines for the Surveillance and Control of Drinking Water Quality

c) For turbidity and chlorine residual tests, rinse out the sample bottle three times before collecting the actual sample. Proceed with chlorine residual and turbidity analyses. In the case of samples for bacteriological tests, the sample bottle must be sterile and should not be rinsed. If the water is chlorinated, the sample bottle should contain a determined percentage of sodium thiosulfate in order to block the action of chlorine. The bottle should not be filled completely, but should be 1/3 empty to facilitate mixing of the sample. Place the lid on the bottle and cover with the kraft paper sleeve.

8.2 Sampling in Open Wells or Storage Reservoirs

a) Fasten the hook at the end of the sampling line through the hole in the sampling vessel.

b) If necessary, tie on an extra length of cord to the line to reach the desired water level. Be very careful not to lose CORD the sampling vessel during this operation.

LINE

Drinking Water Quality Control in Urban Areas 187

c) Lower the sterile vessel into the well or reservoir, being careful not to let it touch the walls. Submerge the sample vessel to approximately 30 cm below the surface of the water.

Carefully raise the vessel. Test for chlorine immediately. If free chlorine residual exceeds 0.5 milligrams per liter and there is no turbidity, there is no justification for a thermotolerant (fecal) coliform test. If turbidity is present and/or free chlorine measures less than 0.5 milligrams per liter, take a sample for the thermotolerant coliform test.

ANNEX 5

TRAINING PROGRAM

Drinking Water Quality Control in Urban Areas 191

Program for Training Course in Sample Collection and Sanitary Inspection

Time Topic Type of Session

8:00 - 8:30 Registration Presentation of participants and 8:30 – 8:45 Group dynamics expectations 8:45 – 9:15 Water and Health Presentation Ideas on control and surveillance of 9:15 – 10:00 Presentation drinking water quality

10:00 – 10:15 Break 10:15 – 10:45 Drinking water quality standards Presentation Characteristics of water supply 10:45 – 11:30 Presentation services 11:30 – 12:30 Sanitary inspection Presentation

12:30 – 13:30 Lunch 13:30 – 14:00 Sanitary inspection Presentation Techniques for sample collection and 14:00 – 14:45 Presentation preservation 14:45 – 15:30 Field analysis Practical work

15:30 – 15:45 Break 15:45 – 16:45 Data management and entry Presentation 16:45 – 17:30 Roundtable discussion Roundtable discussion 17:30 – 17:45 Evaluation of the course-workshop Evaluation 17:45 – 18:00 Closing ceremony

ANNEX 6

SUPPLY AREAS

Table 1. Characteristics of the Supply Areas -SEDACUSCO System Kor-Kor Jaquira Santa Ana Supply area I II III I II I II III IV V VI VII Name El Arco Villa María Independenci Area VI Area VI Area II Area III Area IV Area IV Area V Area VIII Area VIII a Hydraulic area I I I VI VI II III IV IV V VIII VIII Total population 7,600 7,600 3,900 8,000 11,600 7,600 6,300 15,000 11,700 10,800 16,400 5,000 111,500 Population served Source Surface ------PTA-002 PTA-002 PTA-001 PTA-001 PTA-001 PTA-001 PTA-001 PTA-001 PTA-001 Ground Well ------Gallery ------Spring MN-002 MN-002 MN-002 MN-003 MN-003 ------Components Storage reservoir R-32 R-32 R-32 R-39 R-39 R-3 R-3 R-3 R-3 R-3 R-3 R-3 Distribution reservoirs --- R-33 R-35 ------R-4-1 R-4-2 R-2 --- R-7/R-8 Pump station ------Cistern ------Pressure-relief box ------RP-006 RP-003 ------RP-002 --- Service level Home connections 99 99 99 99 99 100 100 100 100 100 100 100 Standpipes 1 1 1 1 1 ------Water tank truck ------Hydraulic micro-zones 1 1 1 1 1 2 3 1 1 2 8 9(VIII) - 15(IX) System Mixed Salkantay Vilcanota Supply area I II IV I II III IV V VI Name Area IX Area IX Area X Area IX Area VII Area VII Area XI Area XI Area XI Hydraulic area IX IX X IX VII VII S. Sebastian Ununchis Larapa Total population 16,400 15,000 13,700 17,200 16,400 16,000 15,000 10,200 15,200 135,100 246,600 Population served Source Surface PTA-1 PTA-1 ------Ground Well PZ-001/004 PZ-001/004 --- PZ-001/004 PZ-001/004 PZ-001/004 PZ-001/004 PZ-001/004 PZ-001/04 Gallery ------GF-001 ------Spring ------Components Storage reservoir R-12 R-12 R-17 R-12 R-12 R-12 R-12 R-12 R-12 Distribution reservoirs R-1 R-1 --- R-13 R-5-1 R-5-2 R-10 R-42 R-48 Pump station ------EB-002/EB- EB-002/EB- EB-002/EB- EB-002/EB- EB-002/EB- EB-002/EB- 003 004 005 006 007 008 Cistern ------CT- CT- CT- CT- CT- CT-

002/CT003 002/CT004 002/CT005 002/CT006 002/CT007 002/CT008 Pressure-relief box ------R-19/R-20/ R-21/R-22/ R- RP-004 ------RP-008 ------23/R-25/ R-29/R-46/ R47

Service level Home connections 100 100 100 99 100 100 100 100 100 Standpipes ------1 ------Water tank truck ------Hydraulic micro-zones 2-3-8-14 9-10-11-12-13-16-17 1-4-5-6-7 1-4 2-3-5 1 1 1

Supplies per source According to SEDACUSCO Population Flow L/s Supply L/inhab-d Piuray 72,800 300.0 293 67,266 385 Jaquira 19,600 27.9 123 18,270 132 Salkantay 13,700 31.6 199 20,666 132 Korkor 19,100 43.5 197 28,438 132 Vilcanota 90,000 158.0 129 124,234 110 Mixed 31,400 ** 211 246,600 258,874 ** Interpolated between Piuray and Vilcanota

ANNEX 7

NUMBER OF SAMPLES

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1. Scope

In accordance with the Guidelines for the Surveillance and Control of Drinking Water Quality and the directives of the regulatory agency (Superintendencia Nacional de Saneamiento– SUNASS), the water and sanitation service company for Cuzco, SEDACUSCO, has reformulated its program for the quality control of drinking water.

The city of Cuzco has a population of approximately 245,000 inhabitants, and is served by five different water supply sources (Kor Kor, Jaquira, Salkantay, Piuray, and Vilcanota), and the distribution network has been divided by the operations office into eleven pressure areas. The water supply system has treatment plants, drilled wells, filtration galleries, springs, storage reservoirs, medium and small distribution reservoirs, pump stations, cisterns and pressure relief chambers (see Annex 3 for details).

The supply areas were determined on the basis of the physical characteristics of the distribution network and the number of components. A supply area is defined as "each of the parts into which the distribution system is subdivided, considering the presence of homogeneous conditions of water quality and pressure and/or operation related to the functioning of the water treatment plant, wells, galleries, springs, reservoirs, pumping chambers, or any other element pertaining to the distribution system, and in which there must reside no more than a determined number of people, according to the supplier's estimation." In this case, the regulatory agency has established that the number of residents in each supply area should not exceed 20,000.

2. Number and Frequency of Samples

To ensure that the drinking water supply system meets the requirements of the regulatory agency, Table 1 of Annex 2 was taken into account, which establishes the analyses to be performed and the number of samples to be collected yearly, from the outlets of treatment plants, reservoirs, and the distribution network. The zoning of the distribution system, as shown in Annex 7, was also taken into consideration.

In addition, the definition of the number of samples took the following factors into consideration:

a) Since the groundwater source known as the Kor Kor spring flows into a distribution reservoir, it was categorized as a reservoir and assigned a larger number of samples.

b) The groundwater source known as the Jaquira spring, because its waters are treated at the plant of the same name, was regarded as a plant outlet even though the sample will be collected at the distribution reservoir fed by the mentioned plant.

200 Guidelines for the Surveillance and Control of Drinking Water Quality

c) The outlet of the Santa Ana treatment plant has been considered as such, even though the sample will be collected at the outlet of the main reservoir which is fed by the mentioned plant. d) The remaining reservoirs larger than 120 cubic meters will be treated as such.

e) Pressure areas were taken as a reference for the identification of the supply areas. To this effect, some of them were subdivided so that the number of inhabitants would not exceed 20,000.

In summary, we have considered two treatment plant outlets, 14 reservoirs, and 21 supply areas.

Table 1 summarizes the number of analytical determinations for each of the main parts of the water supply system.

Table 1. Number of Analytical Determinations per Year – SEDACUSCO

Outlets from sources Distribution Determinations Reservoirs TOTAL Ground Surface network Total coliforms 0 104 168 252 524 Thermotolerant Coliforms 0 104 168 252 524 Turbidity 0 730 168 1,092 1,990 PH 0 730 168 546 1,444 Conductivity 0 730 56 546 1,444 Total hardness 0 8 56 42 106 Chlorides 0 8 56 42 106 Sulfates 0 8 56 42 106 Nitrate 0 8 56 42 106 Color 0 8 56 42 106 Iron 0 8 56 42 106 Manganese 0 8 56 42 106 Aluminum 0 24 0 42 66

In relation to the number of determinations of free chlorine residual, the regulatory agency's directive indicated in Table 2 of Annex 2 was consulted, resulting in the number of samples indicated in the following Table.

Table 2. Number of Chlorine Residual Determinations per Year – SEDACUSCO

Outlets from sources Distribution Reservoirs TOTAL Ground Surface network 0 2,920 6,205 7.665 16,790

Drinking Water Quality Control in Urban Areas 201

3. Cost

Table 3 shows the unit cost demanded for performing each of the analyses, as well as the cost for each of the parts of the water supply system, and the total cost, which amounts to US$ 13,125.00.

It is estimated that water sample collection and other operational expenses may cost US$ 20,000, which would bring the total cost for the drinking water quality control program in the city of Cuzco to approximately US$ 33,000 per year. Divided by the number of people served by the water supply system (245,000), the per capita cost would be US$ 0.14 yearly, or US$ 0.08 per family per month.

Table 3. Cost of Analytical Determinations (in US$)

Unit cost Outlets from Distribution Determinations Reservoirs TOTAL US$ sources network Total coliforms 5.00 520 840 1,260 2,620 Thermotol.coliform 5.00 520 840 1,260 2,620 Turbidity 0.50 365 84 546 995 PH 0.50 365 84 273 722 Conductivity 0.50 365 84 273 722 Total hardness 1.50 12 84 63 159 Chlorides 2.00 16 112 84 212 Sulfates 5.00 40 280 210 530 Nitrate 5.00 40 280 210 530 Color 1.00 8 56 42 106 Iron 5.00 40 280 210 530 Manganese 5.00 40 280 210 530 Aluminum 5.00 120 0 210 330 Chlorine residual 0.15 438 931 1150 2,519 TOTAL 2,889 4,235 6,001 13,125

ANNEX 8

DATA COLLECTION FORMS

Drinking Water Quality Control in Urban Areas 205

Table 1. Distribution Network

Sampling site

Date Address Supply area District Time Sampler Home Home School Others Others Sample number Shop, store Shop, store Chlorine residual Food industry industry Food Public office office Public Other industries

206 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 2. Components

SAMPLING SITE NAME CODE Treatment plant Storage reservoir Distribution reservoir Small reservoir Pump station Cistern Pressure-release box Well Filtration gallery Spring

Date Time Chlorine residual Sampler

Table 3. Treatment Plant

NAME CODE

Sample number Date Time Turbidity pH Conductivity Sampler

ANNEX 9

QUALITY ASSURANCE OF DATA

Drinking Water Quality Control in Urban Areas 209

1. Introduction

The different activities conducted by the water quality control staff should be assessed to ensure the quality of the data collected throughout the evaluation process. Form E-1 is applied for this purpose. It was designed to assess staff performance in five stages:

Number of evaluations conducted Consistency of results Number of direct supervisions Number of field verifications Quality of field work

2. Number of Evaluations Conducted (1)

On Form E-1, opposite the name of the person responsible for the quality control, indicate how many of each type of form have been completed by him/her during the month.

3. Consistency of the Results (2)

The Supervisor should carefully check answers to questions in each of the different types of forms that have been completed and submitted by the control staff in the field.

This revision is to determine whether the person responsible for field work has answered all of the questions in the forms relating to the collection of samples or sanitary inspection and whether, in the supervisor's opinion, the answers are reliable and coherent with reality.

Acceptance or rejection of a form is decided taking into account, in the first place, the number of obligatory answers and, secondly, the reliability of the answers.

If the obligatory questions in each of the forms have not been completely answered, the form is returned so that the person responsible can complete the missing data.

210 Guidelines for the Surveillance and Control of Drinking Water Quality

With regard to reliability of the results, the number of inconsistent answers in the form will be counted, and the form will then be accepted or rejected according to the following criteria:

Number of Questions with Doubtful or Number of Questions per Form Reviewed Mistaken Answers Accept Reject 6 – 8 0 1 9 – 12 1 2 13 – 20 2 3 21 – 30 3 4 31 – 42 4 5 43 – 65 5 6

If in each batch of forms it is found that the number of evaluations or forms completed is equal to or lower than the “accept” number, the information as a whole is accepted. Otherwise, the whole batch is returned to the person in charge of the field work, for revision.

In line 2 of Form E-1, it should be noted whether the forms were accepted (A) or rejected (R).

4. Number of Direct Supervisions (3)

This section refers to the number of times the supervisor helped or supervised the staff responsible for completing the forms. This activity is known as direct supervision or field training. The number of forms which the supervisor helped to complete or supervised is recorded in the appropriate space, for each type of form.

5. Number of Verifications Conducted in the Field (4)

The supervisor is obliged to verify independently the work of the staff responsible for gathering data in the field. To this effect, he selects ten percent of a given type of form, at random, to compare the data recorded with the real situation and thus evaluate the quality of the work performed by the staff member responsible.

The supervisor will record – for each type of form – the number of forms selected and verified in the field.

6. Quality of Field Work (5)

This value is determined for forms selected and verified in the field by the supervisor (step 4).

Drinking Water Quality Control in Urban Areas 211

The supervisor records in line 5 the percentage of errors made by the person responsible for gathering data in the field, referring only to the number of questions answered.

The information is rejected if the percentage of mistaken answers is higher than ten percent (10%).

Example:

The supervisor evaluated three forms of the M-2 type, in which 60 questions were answered in each form, and four, six and five errors were found, respectively. The error is determined as follows:

4 + 6 + 5 x 100 = 8.3% 3 x 60

Number of Forms Questions per Form

212 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM E-1

QUALITY ASSURANCE OF DATA

Date of report ______Supervisor ______

Indicate number of evaluations per type of form conducted by each person

Name of person Evaluation Form* evaluated (1) IS-1 IS-2 IS-3 IS-4 IS-5 IS-6 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

(1) 1. Number of forms completed within the month, per type 2. Consistency of results (A = Accepted; R = Rejected ) 3. Direct supervision (number of forms supervised) 4. Verification in the field (number of forms verified) 5. Quality of work (percentage)

* Sanitary inspection forms and others subject to validation.

APPENDIX C

SURVEILLANCE OF THE QUALITY OF RURAL WATER SUPPLY SERVICES

CASE STUDY: CUZCO, PERU

Surveillance of the Quality of Rural Water Supply Services 215

CONTENTS Page

1. Background...... 219

2. Introduction...... 219

3. Rationale ...... 220

4. Goals and Objectives ...... 221 4.1 Main Goal...... 221 4.2 Specific Objectives...... 221

5. Strategy ...... 221

6. Indicators ...... 222 6.1 Water Quality ...... 222 6.2 Quality of the Service...... 223 6.3 State of Repair of the Components of the Supply System...... 223 6.4 Habits of Hygiene...... 224 6.5 Management of the Supply Services ...... 224 6.6 Diarrheal Diseases and Skin Infections ...... 225 6.7 Rating the Service...... 225

7. Methods and Procedures ...... 225 7.1 Prior Considerations ...... 225 7.2 Planning and Execution ...... 228 7.3 Quality Assurance of Data...... 229

8. Bibliography ...... 230

Annex 1 Responsibilities...... 231

Annex 2 Implementation and Complementation of Laboratories ...... 235

Annex 3 Sampling Parameters and Frequencies ...... 239

1. Introduction ...... 241 2. Physical, Chemical, and Bacteriological Requirements ...... 241 3. Sampling Frequency...... 241 4. Residual Chlorine ...... 241 5. Quality of the Water Supply Service...... 244

Annex 4 Assessment of the Water Supply Service (Miscellaneous Forms and Instructions for Filling Them Out) ...... 245

216 Guidelines for the Surveillance and Control of Drinking Water Quality

Annex 5 Sample Collection and Preservation, and Reporting of Findings ...... 267

1. Introduction ...... 269 2. Containers and Volumes...... 270 3. Selection of Sampling Sites in the Network ...... 272 4. Sample Collection...... 275 5. Identification...... 279 6. Preservation ...... 279 7. Packing and Transportation ...... 280 8. Reporting the Findings ...... 280

Annex 6 Training Program...... 283

Annex 7 Information Flow...... 287

1. Introduction ...... 289 2. Reporting the Findings ...... 289 3. Planning...... 290 4. Information Flow...... 290 5. Notification and Follow up...... 292

Annex 8 Places to be Evaluated...... 297

Annex 9 Determination of Number of Samples ...... 305

1. Scope ...... 307 2. Work Plan...... 307 3. Number and Frequency of Samples...... 307 4. Timeframe for Surveillance of Water Systems (203 Systems Constructed by DIGESA-COSUDE)...... 308 5. Budget...... 308

Annex 10 Sanitary Inspection Report Form ...... 317

Annex 11 Quality Assurance of Data ...... 321

1. Introduction ...... 323 2. Number of Evaluations Conducted (1)...... 323 3. Consistency of Results (2)...... 323 4. Number of Direct Supervisions (3)...... 324 5. Number of Verifications Conducted in the Field (4)...... 324 6. Quality of Field Work (5)...... 324

Surveillance of the Quality of Rural Water Supply Services 217

List of Tables

Annex 2

Table 1 Implementation and Reimplementation of Laboratories ...... 237

Annex 3

Table 1 Bacteriological Parameters ...... 241 Table 2 Parameters that Affect Health...... 242 Table 3 Parameters that Affect Acceptability of the Water...... 242 Table 4 Sampling Frequency (Treatment Plant, Groundwater Sources and Services Reservoirs)...... 243 Table 5 Sampling Frequency (Distribution Network) ...... 243 Table 6 Frequency of Evaluation...... 244

Annex 4

Form M-1 Community Registration Form...... 248 Form M-2 Form to Assess Management and Coverage...... 249 Form M-3 Form to Assess the Sanitary Condition of the Water Supply Infrastructure...... 250 Form M-4 Form for Collecting Water Samples and Assessing the Quality of the Service .... 253 Form M-5 Form to Verify Habits of Hygiene and Presence of Diseases in the Communities 254 Form M-6 Form to Verify Habits of Hygiene in the School Population ...... 256

Annex 5

Table 1 Containers and Type of Preservatives by Group of Determinations ...... 279 Form L-1 Report on Analysis of Water Samples...... 281 Form L-2 Report on Physico-Chemical Analysis of Water Samples...... 282

Annex 7

Form N-1 Letter - Re. Surveillance of the Quality of Drinking Water ...... 293 Form N-2 Letter - Re. Surveillance of the Quality of Drinking Water ...... 294 Form S-1 Summary of Activities Carried Out During the Quarter...... 295 Form S-2 Summary of Activities Carried Out During the Quarter...... 296

Annex 8

Table 1 Water Supply System. SANSABUR Project...... 299

Annex 9

Table 1 Analyses Required in Three Years Planned for Control and Surveillance of Drinking Water Quality ...... 308 Table 2 Chronogram of Activities ...... 308 Table 3 Cost of Analyses...... 309

218 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 4 Sampling Plan for the Surveillance of the Water Quality, and Water Supply Administration and Systems...... 311 Table 5 Summary of the Water Supply Systems. SANSABUR Project Ground and Surface Water ...... 312 Table 6 Number of Samples for Physico-Chemical Analysis Groundwater 2001...... 313 Table 7 Number of Samples for Physico-Chemical Analysis ...... 313 Table 8 Number of Samples for Chlorine Residual Analysis Groundwater – 2001 ...... 314 Table 9 Number of Samples for Chlorine Residual Analysis Surface Water – 2001 ...... 315 Table 10 Projections ...... 315

Annex 11

Form E-1 Quality Assurance of Data...... 326

List of Figures

Annex 5

Annex 7

Figure 1 Information Flow Surveillance of the Quality of the Water Supply Services ...... 291

Annex 9

Figure 1 Program for the Surveillance of Drinking Water Quality, SANSABUR Project ... 310

Surveillance of the Quality of Rural Water Supply Services 219

1. Background

Drinking water quality has a strong impact on people's health because water is a vehicle of transmission for many microorganisms of gastrointestinal origin, pathogenous to human beings. Among the more representative pathogenous agents which may be present in drinking water, we have bacteria, viruses, and to a lesser extent, protozoa and helminths. These microorganisms differ widely in size, structure, and constitution, which explains why their survival in the environment, as well as their resistance to treatment processes, also differ significantly.

Another factor of great importance, especially in rural areas, is the conservation of the quality of water in the distribution system. This factor is linked with: a) state of conservation of the physical infrastructure of the distribution network; b) management of the system; and c) handling of water in the home. At this point we should also mention quantity, continuity, coverage, and cost: taken as a whole, these indicators make it possible to determine the quality of the water supply system and identify its service quality.

2. Introduction

Water for human consumption has been defined in the World Health Organization (WHO) Guidelines for Drinking Water Quality as that water which is “suitable for human consumption and for all normal domestic purposes, including personal hygiene.” Implicit in this definition is the principle that this water should not present any kind of health risk such as chemical irritation, intoxication, or microbiological infection harmful to human health.

The microbiological quality of drinking water is of a great primary importance, and the monitoring of bacterial indicators such as total coliforms and thermotolerant coliforms should be given the highest priority. Chemical pollution is also very important, but it is not associated with acute effects on human health, and has a lower short-term priority than bacteriological contamination. Chemical pollution therefore often becomes irrelevant in areas where water-related microbiological and parasitic diseases are strongly prevalent.

220 Guidelines for the Surveillance and Control of Drinking Water Quality

factor, of great importance in developing countries where there is a shortage of water, is the interruption of the supply as a result of rotation of service from one supply area to another.

In low-reliability systems, the constant interruption of the water supply system leads to the deterioration of the physical, chemical, and especially the microbiological quality of water at the home level, because of inadequate handling and storage.

The concepts and procedures set forth in this document are based on the Guidelines for the Surveillance and Control of Drinking Water developed by the Pan American Center for Sanitary Engineering and Environmental Sciences (PAHO/CEPIS), with the financial support of the U.S. Environmental Protection Agency (EPA). With a view to validating the methodology in a rural environment, CEPIS came to an agreement with the Saneamiento Básico de la Sierra Sur project (SANBASUR) to set up a pilot project in the Cuzco Health Region, where SANBASUR is sponsoring the construction of water supply and sanitation systems in cooperation with the Ministry of Health, specifically the Ministry's Dirección Ejecutiva de Salud Ambiental del Cuzco (DESA-CUZCO) [Executive Office of Environmental Health for Cuzco].

The methodology to be applied is designed to determine the sanitary condition of the rural water supply services, by evaluating: a) drinking water quality; b) state of repair of the system's components; c) the quality or level of service; d) habits of hygiene; e) the state of the management or administration of the water supply system; and f) water-related diseases, in order finally to conclude with the rating of the service.

3. Rationale

There is ample literature on the way the conditions of the infrastructure affect the quality of drinking water. Defects and shortcomings in the infrastructure may be the result of bad design, bad construction (or construction supervision), or poor maintenance. They may also be caused by natural or human factors, such as earthquakes or social disruptions, which render the structures of the water supply system unable to protect and maintain the drinking water quality.

Another important factor is the community's attitude to the water supply system. In this reference, two fundamental and closely related components may be distinguished: a) the organization responsible for administering the water supply, and b) the response of the consumers. If the water supply service is to be sustainable, the community in question must have a functional organization in charge of managing and operating the supply system in such a way as to provide an adequate service. This organization will need to have individuals trained in administration, operation, maintenance and the communication of educational messages to the beneficiary population. The community must also be capable of recognizing the service received and making a fair payment for it. The tariffs paid by the consumers will serve to pay the members of the functional organization responsible for the administrative and/or technical tasks, as well as to purchase the inputs and materials necessary for the good operation and maintenance of the water supply system.

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The quality of the supply service is another factor of great importance for the improvement of the beneficiary population's health. Ideally, the whole community should be served efficiently and effectively. However, it is often the case that the water supply service has limited coverage and/or very low continuity. This means that many of the population have to resort to other sources of water and/or store water to cover their basic needs, which results in the deterioration of the water quality and the consequent exposure of consumers to communicable water-related diseases.

Finally, it is considered that raising the level of hygiene of the beneficiary population is another factor conducive to improving their health. It is known that populations with poor habits of hygiene are more exposed to communicable diseases than those with better habits of hygiene. We have therefore included in the methodology for the surveillance of water quality in rural areas, the conduction of an evaluation of habits of hygiene as a means of identifying the hygiene education activities required to improve them.

4. Goals and Objectives

4.1 Main Goal

To set down the bases for implementation by the SANBASUR Project of a program for the surveillance of the quality of rural water supply services in the Cuzco Health Region, in order to determine the sanitary conditions of said services.

4.2 Specific Objectives

a) To determine the quality of the water used for human consumption; b) to determine the quality of the water supply service; c) to determine the extent of deficiencies in the components of the water supply systems; d) to determine the habits of hygiene of the populations attended by the water supply services; e) to determine the state of the management of the water supply systems; f) to determine the prevalence of acute diarrheal diseases (ADD) and skin diseases; and g) to evaluate the water supply service.

5. Strategy

The objectives will be reached as follows:

• The quality of drinking water in the distribution system will be determined by physical, chemical, and bacteriological evaluation of the water, from the catchment to the home connection or community supply point (public standpipe or well). • The quality of the service will be determined using two sets of survey questions, one set applied to the members of the Water Board and the other to the users of the water supply service.

222 Guidelines for the Surveillance and Control of Drinking Water Quality

• The condition and degree of conservation of the water supply infrastructure will be quantified by direct inspection of the main system components, to identify any defects that may affect the conservation of the drinking water quality. • The habits of hygiene of the population benefiting from the water supply service will be determined by applying verification surveys to a number of consumers selected at random. The number of consumers to be surveyed will be defined by applying the sampling theory. • Management of the water supply system will be assessed by analyzing the work done by each of the members of the Water Board. • The prevalence of diarrheal diseases and skin diseases will be verified using surveys applied at random among the population served by the water supply system. • The service quality will be scored based on a weighting of the indicators associated with the quality of the water and quality of the water supply service, among others.

The information will be gathered by applying five questionnaires, which cover the five fields of interest, namely: a) water quality and service quality; b) condition of the infrastructure; c) habits of hygiene and prevalence of acute diarrheal diseases and skin diseases; d) state of the management; and e) aspects connected with the community or populated center. The staff of the Peripheral Health Facilities of DESA-Cuzco will conduct these surveys.

6. Indicators

Corresponding to the objectives indicated above, the result indicators which will be obtained from the program for the surveillance of rural water supply services are: a) water quality; b) continuity, coverage and uses of the water (quality of service); c) state of conservation of the components of the water supply system; d) habits of hygiene; e) state of the management or administration; and f) acute diarrheas and skin diseases; being complemented with the rating of the water supply service.

6.1 Water Quality

Water distributed through the supply systems should be innocuous. To accomplish this, water quality must comply with the physical, chemical, and bacteriological standards set by the health authorities, to ensure that the water will not be harmful to consumers' health.

In the specific case of rural water supply systems, the analytical parameters were selected bearing in mind such aspects as: a) accessibility to the community, b) typical features of rural systems, and c) availability of economic, human, and material resources. It was considered appropriate that the water quality evaluation give priority to the testing of a group of basic parameters associated with water-borne diseases, as recommended by the World Health Organization, such as: turbidity, pH, chlorine residual, and thermotolerant (fecal) coliforms.

The tests will also include sporadic physical and chemical determinations, to build up a more complete picture of the quality of the water consumed by the rural population attended by

Surveillance of the Quality of Rural Water Supply Services 223

the community water supply services. It was also decided that the chlorine residual and pH determinations would be effected in the field; the turbidity and thermotolerant coliforms in the local laboratories, and the physical, chemical and metals analyses in the central laboratory. The determinations of chlorine residual and pH can be effected using colorimetric comparators and turbidity can be tested using nephelometric tubes.

6.2 Quality of the Service

In the present case, we have considered that the service quality can be assessed by determining the functional characteristics of the water supply system, such as a) coverage of the service; b) continuity of the water supply; and c) good use of the water supplied. This last factor can be interpreted as an indirect indicator of the amount of water consumed, which can be qualified in terms of "adequate consumption" or "wasteful consumption." Also, the potential extension capacity of the water supply system can be estimated taking into account the availability of water at the source.

6.3 State of Repair of the Components of the Supply System

Conservation of the quality of drinking water is dependent on the absence of physical defects in the components which make up the water supply system; as well as the availability of protective elements for the conservation of the water's physical, chemical, and bacteriological characteristics.

It was thought best that the evaluation of the level of deficiencies of the components of the water supply service should be effected for the four basic supply schemes, which have diverse and common aspects. The diverse aspects of each of the schemes are the types of source, catchment, or treatment, while the common aspect shared by the four is the distribution system itself.

The four water supply schemes considered are:

• Gravity-fed without treatment: catchment can be spring, filtration gallery, and direct supply; • Gravity-fed with treatment: catchment and water treatment plant;

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• Pumped, without treatment: water well and pumping equipment; and • Pumped, with treatment: catchment, treatment plant, and pumping station.

With regard to the common aspects of the supply schemes, the following components have been considered: a) supply line/pumpline; b) air-vents or pressure-relief boxes; c) reservoirs; d) feeder main; e) distribution network; f) public standpipes; g) home connections.

6.4 Habits of Hygiene

Habits of hygiene are known to have a direct link with communicable diseases and it is also widely known that in populations with poor habits of hygiene the hygiene education programs contribute to improving the people's health. We can even affirm that the impact of hygiene education programs is far greater than that of the quality and quantity of the water supplied.

Improvement in the habits of hygiene of the populations with the greatest health problems is a slow process involving the permanent training of beneficiary populations to improve their customs until new good habits have gradually taken root. Constant practice over a long period is necessary, and this must be constantly evaluated and reinforced to ensure that the knowledge imparted in the training is first assimilated as a new attitude, and subsequently consolidated.

In this case, the habits with the greatest influence on the control of communicable diseases were selected, namely those linked with the handling of water, personal hygiene, the disposal of excreta, and hygiene in the home.

6.5 Management of the Supply Services

Recent studies have shown that the management or administration of rural water supply services has a strong influence on the conservation of drinking water quality. A weak management, which does not enforce the collection of a water tariff for the service rendered to the community, will be incapable of maintaining a person part-time or full-time for the proper operation and maintenance of the water supply service; and there will be no funds with which to purchase the spare parts or raw materials needed for efficient operation of the system or even for disinfecting the water.

In this context, it is indispensable that the following three basic aspects be evaluated: a) consistency of the water tariff; b) operation and maintenance; and c) payment of the operator. Tariff consistency is the relationship between: a) amount of the tariff; b) punctual payment; c)

Surveillance of the Quality of Rural Water Supply Services 225

existence of an operator for operation and maintenance of the system; and d) time the operator spends on his work.

6.6 Diarrheal Diseases and Skin Infections

Basic sanitation work seeks to improve the overall health of the beneficiary populations, and in particular to control to a greater or lesser degree the incidence of water-related communicable diseases. Surveillance of water quality in rural areas should therefore consider the periodic evaluation of cases of diarrhea and skin infections to identify their causes which, especially in the rural environment, may be linked with water quality and the habits of hygiene of the consumers.

In light of the economic constraints and the complexity of gathering data linked with cases of diarrhea and skin infections in each community, it was decided that for this project random surveys would periodically be conducted in consumers' homes in order to estimate the incidence of these diseases. The sampling theory will be applied to determine the number of homes where the surveys are to be applied, which will be evenly spread throughout the community being evaluated.

6.7 Rating the Service

To compare the quality of the service rendered by the water supply systems, it is planned to weight a certain group of indicators (mentioned above) in such a way that a score or rating can be given to the service being assessed. This score will make it possible to determine which supply services are the best ones and which are the least efficient. This information, in turn, will serve to prioritize the implementation of remedial measures for the improvement, rehabilitation or expansion of the water supply service in the worst affected or least efficient systems.

7. Methods and Procedures

7.1 Prior Considerations

Before embarking on the program of surveillance of rural water supply services it is necessary to define the unit, within the Executive Office of Environmental Health (DESA- Cuzco), responsible for implementing the program, the responsibilities of each one of its members, the furniture and supplies necessary for the office concerned, the equipment and chemical supplies needed for the central and peripheral laboratories, criteria for drinking water quality, manuals of procedures for surveillance of the rural water supply services, training programs and the information system, among other considerations.

a) Responsibilities: It is assumed that DESA-Cuzco will be the head of the system of surveillance of quality of the rural water supply services in the Cuzco Health Region; and that the heads of Health Networks through the "micro-networks" and these, in turn, through the peripheral health posts and centers, will be responsible for gathering

226 Guidelines for the Surveillance and Control of Drinking Water Quality

information from the field. However, internal guidelines will need to be issued to specify the functions and responsibilities of each of the participants in the planned surveillance program. See Annex I.

b) Basic equipment: At the central and district levels the minimum indispensable facilities are available for carrying out the surveillance of the quality of rural water supply services. Among the facilities available are: physical space, equipment (desks, computers, etc.). In the case of the present project, DESA-Cuzco has the required facilities and material.

c) Laboratories: The central laboratory has several material resources appropriate to the level of surveillance planned for the region. In general terms, the laboratory materials available are:

• Furniture • Chemicals for physico-chemical analyses • Equipment and instruments • Culture media (bacteriological) • Glassware

The small district laboratories ("local laboratories") also have the facilities they need to perform the analyses for which they are responsible. The existing materials and those that need to be repaired or replaced at the level of each type of laboratory are shown in Annex II.

d) Water quality criteria: The goal of the criteria for drinking water quality is to remove harmful factors or reduce the concentration of such parameters to below levels harmful to health, in order to contribute to the conservation of the health and well-being of the people served by the water supply system. Annex III gives the sampling parameters and frequency for evaluating the drinking water quality and the level of service in the present program.

e) Manuals of procedure: In order to standardize the procedures for conducting the surveillance program, operation manuals will have to be distributed, in which the tasks of all those involved are clearly defined.

Gathering of information: In order to obtain information five forms have been designed: a) community registration; b) management and coverage: c) sanitary inspection and disinfection; d) water quality and Service quality; and e) habits of hygiene, diarrheal diseases and skin infections. Annex IV contains models of the forms and instructions for filling them out.

Sample collection and analysis: The sampling must be carried out by trained personnel to ensure that the water samples are representative of the supply system and that they will not be contaminated during the sampling and transportation processes. To that end, staff must be trained to comply strictly with the procedures of sampling, preservation, packing

Surveillance of the Quality of Rural Water Supply Services 227

and transportation of samples to the laboratory. They must also be trained to determine in the field the free chlorine content, pH and certain other types of information relative to the supply system. The staff in charge of this work must therefore be exclusive and enjoy the absolute trust of the surveillance office.

The sampling sites must be selected in such a way that they are representative of the water supply system.

Preferably, the sampling points will be:

• Outlets from springs • Outlets from water wells • Outlets from water treatment plants • Outlets from components (storage or distribution tank, pressure-relief chambers, etc.) • Pumplines and feeder mains • Distribution network. The sampling points must be spread evenly throughout the distribution system and be proportional to the number of users, taking into account: - Sites of social responsibility such as: health centers, schools, places of mass food preparation, public standpipes. - Dead points, low pressure points or restricted supply points in distribution networks.

Annex V shows the sampling method to be applied in the present program.

With regard to the analyses to be carried out by the central laboratory, it is recommended that they follow universally accepted procedures, in order to guarantee the results of the analyses and render them comparable. It is recommended that the Standard Methods for the Examination of Water and Wastewater (APHA, AWWA and WEF, 1995) be adopted. f) Training: The training program must involve all tiers of the organization connected with the surveillance program, paying special attention to the formation of the staff responsible for field activities and information processing.

The quality of the information produced by the surveillance agency depends on the work carried out by the staff responsible for taking samples, conducting sanitary inspections, performing analyses, processing information, etc. For this reason the staff must be trained to do their work to a high standard. A good training program will ensure that the data and their processing will be standardized and comparable among the different generators of information, thereby facilitating systemization at the regional and national level. The training should be designed to prepare personnel in:

• Planning the task; • Identifying the characteristics of the water supply services; • Evaluations and identification of health risks; • Collection and preservation of samples; • Field analyses;

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• Microbiological, physical and chemical analyses; • Processing of information; and • Interpreting and reporting results

Annex VI contains a model training program for staff in charge of field activities.

g) Information system: The impact of the surveillance program is based on results and on the application of these results. It is therefore necessary to define how the information should flow from the evaluated community to the Regional Health Authorities, passing through the heads of the micro-networks and the heads of networks. Finally, the production of periodic reports on the conditions of the water supply systems and their principal defects should be considered as a final product. See Annex VII for a chart showing the information flow proposed for this project.

7.2 Planning and Execution

The activities involved in the work of surveillance of the quality of rural water supply services are:

a) Planning: Before beginning its surveillance work, the surveillance agency must obtain general information about the communities it plans to work in: the type of water supply service they have, population size, public establishments – especially those relating to education and health – other basic services, and accessibility, in order to identify the facilities already existing in the community and which could be helpful in the surveillance work in general.

In addition, planning should include the definition of:

A list of the localities to be evaluated in the next three years, as well as the type and number of determinations to be performed, together with their cost, is shown in Annex VIII. Annex IX shows the number of determinations.

Surveillance of the Quality of Rural Water Supply Services 229

b) Execution: After planning the different activities involved, the surveillance agency can proceed with its work. The following tasks have been defined: a) gathering information; b) sampling and testing; c) identifying corrective measures; d) analyzing information and e) reporting. See Annex IV.

c) Analysis of the information: The analysis of the information will permit the rating of six basic aspects: a) drinking water quality; b) service quality; c) condition of the infrastructure; d) level of hygiene; e) system management; and f) prevalence of diarrheal diseases and skin infections. In addition, taking into account these six aspects, the service as a whole can be rated and given an overall score. The significance of the overall score is that it will enable the water supply systems to be compared with each other.

With reference to water quality, it will be classified in groups according to its origin, thus considering: a) outlet from the plant, spring or well; b) outlet from the intakes such as reservoirs and pressure-relief chambers in the distribution system; c) secondary distribution system and public standpipes; and d) storage containers within the home, if justified by circumstances.

d) Corrective measures: After gathering the information and taking samples, the person in charge of field work will be in a position to identify the main problems in the water supply system that has been evaluated.

As a way of contributing to the community, the surveillance agency will distribute copies of its report on the principal defects encountered in the supply service to the administrator of the community Water Board and to the corresponding District Municipality. The community will then be able to apply remedial measures or seek support to improve its water supply service. Annex X contains a model of the report that will be given to the community listing the defects found in the course of the surveillance work.

7.3 Quality Assurance of Data

The data obtained by the surveillance personnel will be subject to validation to ensure accuracy. The evaluation of the performance of the persons responsible for field work is five- fold:

• Number of evaluations carried out; • consistency of the results; • number of direct supervisions; • number of verifications in the field; • quality of field work.

See Annex XI for the procedure to be carried out in assuring the quality of the data.

230 Guidelines for the Surveillance and Control of Drinking Water Quality

8. Bibliography

1. “Abastecimiento de Aguas y Disposición de Excretas” – Ministry of Health, Bureau of Environmental Health, Pevention and Control of Cholera - Colombia, 1991.

2. “Drinking Water Quality Control in Small Community Supplies” – Guidelines for Drinking Water Quality, Geneva, WHO, 1983.

3. “Control de Calidad del Agua en la Red de Distribución” HDT CEPIS 67 – September- December 1996.

4. “Seminar on the Control and Surveillance of Water Quality in Rural Communities – El Salvador: Ministry of Public Health and Social Assistance: National Program of Rural Basic Sanitation.” – PAHO - Mexico D.F., 1995.

5. “Evaluation for village water supply planning” Sandy Cairncross, Ian Carruthers, Donald Curtis, Richard Feachem, G. Richard, David Bradley, George Baldwin. – Chichester, 1980.

6. “Informe del Programa de Vigilancia de la Calidad del Agua” – Ministry of Health – DEL AGUA- Peru, 1986.

7. “Interim evaluation of the WHO/UNEP drinking-water quality surveillance projects under implementation in the countries of Indonesia, Peru and Zambia” – Mauricio Pardón – DEL AGUA, 1987.

8. “Pilot Rural Water Surveillance project in Indonesia” – Barry Lloy- Sri Suyati – January 1989.

9. “Propuesta de un Sistema de Información sobre Calidad de Agua y Saneamiento SICAS” – Jairo Niño Buitrago – Ministry of Health - Colombia, 1992.

10. “Surveillance of drinking water quality in rural areas” – Barry Lloyd, Richard Helmer – WHO, 1991.

11. “Vigilancia de los Servicios de Agua de Consumo Humano - Manual del Supervisor Secciones I, II y VIII” - Ministry of Health - Robens Institute - Peru, June 1990.

12. “Vigilancia y Control de Calidad del Agua: lo que Debemos Conocer y Hacer” MINSA- APRISABAC – Peru, 1989.

ANNEX 1

RESPONSIBILITIES

Surveillance of the Quality of Rural Water Supply Services 233

Among those involved in the surveillance of drinking water quality, we have the members of the community Water Board, the sanitary technicians or inspectors, the laboratory workers at the peripheral (local) level, the staff of the central laboratory, and the professionals responsible for rural surveillance. Their responsibilities are as follows:

Water Board: The members of the Water Board should accompany the sanitary technician or inspector to collect the water samples for analysis, verify that the field analyses are properly performed, provide any support required for the sanitary inspection, supply information about the management of the water supply system, and participate in the evaluation of habits of hygiene and determination of diseases prevalent in the community.

Sanitary inspector or technician: Following the plan drawn up by the surveillance agency, he/she should obtain the water samples from the water supply system using the prescribed procedures and placing particular emphasis on the catchment, the storage reservoir and home connections. He/she should also perform the basic determinations: pH, free chlorine residual and, if possible, turbidity.

The sanitary inspector or technician should participate, together with the members of the Water Board, in the sanitary inspection, the assessment of the administrative management of the water service, and the gathering of information on habits of hygiene, diarrheal diseases and skin infections. On completion of the evaluation of the system, the sanitary inspector or technician should write the inspection report listing the main problems detected during the inspection.

The sanitary inspector or technician should send the water sample(s) to the local laboratory, report the findings of the field analyses to the pertinent office, and send in all the completed questionnaires. Finally, once he/she has the results of the analyses reported by the local and central laboratories, he/she should proceed to notify the community of these findings, together with a list of the remedial measures to be implemented by the community Water Board in order to improve the water supply system.

Laboratory worker in the local laboratory: This worker is responsible for the determination of thermotolerant coliforms and turbidity, if circumstances call for it. It is his job also to send the water samples for physico-chemical and metal analyses to the central laboratory, and report the test results to the sanitary inspector or technician and the pertinent authorities. He should also prepare the flasks for the collection of bacteriological samples.

Central laboratory: The staff member responsible should perform the physico-chemical and metal analyses on the water samples sent in by the district laboratories and report the test findings to the pertinent authorities. He/she should also prepare the flasks for the collection of samples for the physico-chemical and metal analyses and send them to the local laboratories in good time.

Executive Office of Environmental Health (DESA-Cuzco): This office is responsible for periodically processing all the information sent in by the health services in charge of water

234 Guidelines for the Surveillance and Control of Drinking Water Quality

quality surveillance, and for identifying any corrective measures that need to be implemented by the communities and which may not have been observed by the field staff. This office also performs follow-up on the corrective measures and should report to national institutions and planning agencies on the condition and rating of the rural water supply services that have been assessed.

ANNEX 2

IMPLEMENTATION AND COMPLEMENTATION OF LABORATORIES

Surveillance of the Quality of Rural Water Supply Services 237

Table 1. Implementation and Complementation of Laboratories

Laboratory Equipment available Complementary equipment

Cuzco Microbiology area • Bacteriological incubator Technical area • Dry sterilizers • Computer equipment • Water still • Double boiler Microbiology area • Membrane filtration apparatus • Laboratory materials and supplies • Retorts • Analytical balance • Portable kit for bacteriological analyses Physico-chemical area Physico-chemical area: • Fume hood • pH meter • Turbidimeter • Spectrophotometer • Laboratory materials and supplies • Portable kit for physico-chemical analysis of water • Oven • Oximeter Quispicanchi Microbiology area • Dry sterilizer Repair and calibration of analytical • Bacteriological incubator balance • Double boiler Laboratory materials and supplies • Water still • Portable filtration kit • Vertical retort • Analytical balance Paruro Microbiology area • Dry sterilizer Laboratory materials and supplies • Bacteriological incubator • Double boiler • Water still • Portable filtration kit • Vertical retort • Analytical balance Chumbivilcas Microbiology area Laboratory materials and supplies • Dry sterilizer • Bacteriological incubator • Double boiler • Water still • Portable filtration kit • Vertical retort • Analytical balance La Convención Has no laboratory material or equipment Microbiology area • Dry sterilizer • Bacteriological incubator • Double boiler • Water still • Portable filtration kit • Vertical retort • Analytical balance

ANNEX 3

SAMPLING PARAMETERS AND FREQUENCIES

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1. Introduction

For the Drinking Water Quality Surveillance Program to be implemented in the Cuzco Health Region, the SANBASUR Project, with the approval of the Executive Office of Environmental Health for Cuzco (DESA-Cuzco) - Ministry of Health, has selected a set of parameters to evaluate the quality of the drinking water.

2. Physical, Chemical, and Bacteriological Requirements

Tables 1 to 3 show the determinations to be adopted in the Program, as well as the acceptable concentrations.

3. Sampling Frequency

Tables 4 and 5 show the sampling frequencies specified for the source, the components of the water supply system, and the water distribution network.

4. Residual Chlorine

The presence of residual chlorine is not an indispensable requirement for the assessment of drinking water quality. However, its determination is considered a decisive element in the performance of the bacteriological analysis. To this effect, the determination of residual chlorine should be executed in different parts of the supply system at least once a month and during the collection of water samples for bacteriological analysis.

Table 1. Bacteriological Parameters

Coliforms (UFC/100 mL) Sampling site Total Thermotolerant Entrance to the distribution system (1) 0 0 In the distribution network (2) 0 0

(1) 100% of the water samples analyzed during the year should indicate zero presence of total and thermotolerant coliforms.

(2) 95% of the water samples analyzed during the year should indicate zero presence of total coliforms, although up to 10 total coliforms /100 mL sporadically in non-consecutive samples is accepted.

242 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 2. Parameters that Affect Health

Parameter Unit of measurement Maximum concentration

Arsenic mg/L as As 0.050 Cadmium mg/L as Cd 0.010 Chromium mg/L as Cr 0.050 Fluoride mg/L as F 1.5 Mercury mg/L as Hg 0.001

Nitrate mg/L as NO3 45 Lead mg/L as Pb 0.05

Table 3. Parameters that Affect Acceptability of the Water

Maximum concentration Parameter Unit of measurement Recommended Admissible Turbidity NTU 5 10 pH pH unit 7.0 – 8.5 6.5 – 9.2 Aluminum mg/L as Al 0.1 0.2 Calcium mg/L as Ca 75 150 Zinc mg/L as Zn 5.0 15.0 Chloride mg/L as Cl 250 500 Copper mg/L as Cu 0.05 0.5

Total hardness mg/L as CaCO3 200 500 Iron mg/L as Fe 0.1 1.0 Magnesium mg/L as Mg 30 100 Manganese mg/L as Mn 0.05 0.5

= Sulphate mg/L as SO4 250 400 Total residual mg/L 500 1,500

Surveillance of the Quality of Rural Water Supply Services 243

Table 4. Sampling Frequency (Treatment Plant, Groundwater Sources and Service Reservoirs)

Type of water source Parameter Ground Surface

Coliforms 6 samples per year Turbidity pH 12 samples per year Arsenic Cadmium Chromium Fluoride 1 sample every two years 1 sample per year Mercury Nitrate Lead Aluminum Calcium Zinc Chloride Copper Total hardness 1 sample per year 2 samples per year Iron Magnesium Manganese Sulphate Total residual

Table 5. Sampling Frequency (Distribution Network)

Sampling Size of Number of Parameter frequency population samples per (Inhabitants) locality Coliforms 6 samples per year <200 1 Turbidity, pH and 201 – 800 2 chlorine residual 12 samples per year 801 – 2,000 3

244 Guidelines for the Surveillance and Control of Drinking Water Quality

5. Quality of the Water Supply Service

The rural water supply services will be periodically evaluated with the frequency indicated in Table 6.

Table 6. Frequency of Evaluation

Activity/field Form Frequency Community registration M-1 Once only Management and coverage M-2 Quarterly Sanitary conditions of the water supply infrastructure M-2 Every two months Water quality and service quality M-4 Every two months Habits of hygiene and presence of diseases in the M-5 Quarterly community Habits of hygiene in the school population M-6 Quarterly

ANNEX 4

ASSESSMENT OF THE WATER SUPPLY SERVICE (Miscellaneous Forms and Instructions for Filling Them Out)

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The SANBASUR Project, with the approval of the Executive Office of Environmental Health for Cuzco (DESA-Cuzco) - Ministry of Health, has defined the aspects to be assessed, as follows:

• Registration of the community; • management and coverage; • sanitary condition of the water supply infrastructure; • water quality and service quality; • habits of hygiene and presence of diseases in the community; • habits of hygiene in the school population.

Registration of the community: This information is obtained by applying Form M-1, which should be done at the outset of work in the community, and subsequently any time that a substantial change in its characteristics is observed. The replies are obtained by direct observation or by asking the community authorities.

Management and coverage: This information is collected by applying Form M-2 every three months. The questions are asked of the members of the community Water Board.

Sanitary condition of the water supply infrastructure: The sanitary inspections will be conducted every two months and should coincide with the collection of samples for analyses of thermotolerant coliforms, pH and turbidity. Form M-3 is used for this, and the data are gathered by the inspector jointly with the operator and the members of the Water Board.

Water quality and service quality: For this assessment Form M-4 is applied every two months. This work is performed jointly with the operator and the members of the Water Board.

Habits of hygiene and presence of diseases in the community: These data are obtained using Form M-5 and the frequency of gathering this information is quarterly. Most of the questions are replied to by direct observation.

Habits of hygiene in the school population: The data are obtained by applying Form M-6, quarterly as in the previous case.

248 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM M-1

COMMUNITY REGISTRATION FORM

1. Location Community ______CODE ______Annex/Sector ______District ______Province ______Department ______Total Population ______Number of families ______Health facility for referral ______

2. Accessibility

Distance Time Type of Means of From To (1) (2) (km) (Hours) Road Transportation

(1) Paved local road, packed dirt road, trail. (2) Vehicle, pack animal, on foot.

3. Additional Basic Services

Electricity F Telephone F Phone number ______Radio F Radio frequency ______

4. Schools

Pre-school F Elementary F High school F Others: ______

Date: ______

Name of survey conductor: ______

Signature ______

Surveillance of the Quality of Rural Water Supply Services 249

FORM M-2 FORM TO ASSESS MANAGEMENT AND COVERAGE

1. Location Community ______CODE ______District ______Province ______

2. Management 2.1 Responsible for administration of the water service Community Water Board F Municipality F Community Leaders F Others F ______Duration of position (as per bylaws) ______years How long in office? ______years 2.2 Revenues Amount of payment for water service S/. Period Number of connections Home connection ______Public standpipes ______Tariff in force for ______years 2.3 Punctuality Percentage of consumers who pay punctually for the water service ______% 2.4 Extraordinary contributions Do consumers made an extraordinary contribution? Yes F No F 2.5 Operation and maintenance Does the service have an operator/plumber/other? Yes F No F If so, how much time does he spend on the service? Full time F As required F Part time F 2.6 Administration costs (per month) Administration (members of management unit) S/. ______Operators S/. ______Materials Chlorine S/. ______Piping, glue, accessories S/. ______3. Coverage Number of housing units ______Number of home connections ______Number of public standpipe connections ______Number of homes not supplied ______Date: ______

Name of survey conductor: ______Signature ______

250 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM M-3 FORM TO ASSESS THE SANITARY CONDITION OF THE WATER SUPPLY INFRASTRUCTURE

1. Location Community ______Code ______District ______Province ______

2. The Drinking Water System

Age ...... Executing Agent ...... Operation: Continuous F Restricted F

3. Type of Supply System

Gravity-fed without treatment F Gravity-fed with treatment F Pumped without treatment F Pumped with treatment F

4. Source In times of drought can more be supplied? YES F NO F

Groundwater G w/o T G w T P w/o T P w T Spring water, intake in the spring F Answer question 4.1 x Deep well F Answer question 4.2 Sub-surface water (filtration gallery) F Answer question 4.3 x x Surface water with treatment F Answer question 4.4 x x

4.1 Intakes and Water Reunion Boxes Number of: intakes ...... water reunion boxes …......

Intakes Reunion Boxes Characteristics 1 2 3 1 2 3 Is there a protecting fence? Is there a surface water diversion ditch, and is it in good condition? Is there a lockable sanitary lid in good condition? Is the structure in good condition and without cracks or leaks? Is the inside of the structure clean and free from foreign matter? Absence of puddles of water or fecal matter within a 20-m radius? Sample Code

4.2 Deep Well Drilled F Dug F Depth ...... m

Does it have housing and is it protected against entry of people and/or animals? Is the pump mounted on an uncracked concrete slab, more than 4 m in diameter? Is the mouth of the well above the level of the concrete slab? Absence of puddles of water or fecal matter within a 20-m radius? SAMPLE CODE

Surveillance of the Quality of Rural Water Supply Services 251

4.3 Filtration Gallery and Water Reunion Boxes Number of water reunion boxes……

Gallery Reunion Boxes Characteristics 1 2 3 Is there a protecting fence? Is there a lockable sanitary lid, in good condition? Is the structure in good condition and without cracks or leaks? Is the inside of the structure clean and free from foreign matter? Absence of puddles of water or fecal matter within a 20-m radius? SAMPLE CODE

4.4 Surface Water with Treatment

SOURCE: Stream F Lake/lagoon F River F Gully F OtherF ...... SUPPLY: Pumped F Gravity-fed F Treatment Processes: Flocculation F Sedimentation F Pre-filtering F Filtering F Is there a protecting fence? Are the treatment structures free from risk of accidental flooding? Is the structure in good condition and without cracks or leaks? Is the inside of the structure clean and free from foreign matter? Absence of puddles of water or fecal matter within a 20-m radius? SAMPLE CODE

5. Conduction System

5.1 Conduction Line / Pumpline Absence of leaks? Is the whole length of the pipeline underground? Are the above-ground crossings protected and in good condition?

Air Vent P.R.B. 5.2 Air-vents and Pressure-Relief Boxes in the Conduction Line 1 2 3 1 2 3 Is there a lockable sanitary lid, in good condition? Is the structure in good condition and without cracks or leaks? Absence of puddles of water or fecal matter within a 20-m radius?

6. Distribution System

6.1 Reservoir 1 2 Is there a protecting fence? Is there a lockable sanitary lid, in good condition? Is the structure in good condition and without cracks or leaks? Is the inside of the structure clean and free from foreign matter? Absence of puddles of water or fecal matter within a 20-m radius? Sample Code 6.2 Feeder Main Absence of leaks? Is the whole length of the pipeline underground?

252 Guidelines for the Surveillance and Control of Drinking Water Quality

6.3 Pressure-Relief Boxes 1 2 3 4 Is there a lockable sanitary lid, in good condition? Is the structure in good condition and without cracks or leaks? Absence of puddles of water or fecal matter within a 20-m radius?

6.4 Distribution Network Absence of leaks? Is the whole length of the pipeline underground? Are the valve boxes dry?

6.5 Public Standpipes PP1 PP2 PP3 PP4 PP5 Is the structure in good condition and without cracks or leaks? Is the structure clean? Are the accessories and/or tap complete and in good condition? Absence of puddles of water or fecal matter within a 20-m radius?

7. Chlorination

Frequency of water chlorination: Always F Sometimes F Never F Is chlorination equipment available? Is the equipment in good condition? Is the equipment in use at the time of the visit? Is there a stock of chlorine?

Date: ______

Name of survey conductor: ______

Signature______

Surveillance of the Quality of Rural Water Supply Services 253

FORM M-4

FORM FOR COLLECTING WATER SAMPLES AND ASSESSING THE QUALITY OF THE SERVICE

1. Location Code ______

Locality ______District ______Province ______Department ______

2. Samples 2.1 Distribution network Time of Chlorine Number of sample (1) Home Address Name of user sampling residual pH / turbidity Coliforms 1 2 3 4 5 6

2.2 Components Number of sample (3) Chlorine No Type (2) Time of sampling pH / turbidity Coliforms Physico- residual Metals chemical 1 2 3 (1) To be carried out by the local laboratory. (2) Intake, reservoir, pressure-relief chamber, etc. (3) Analysis of pH, turbidity and coliforms to be performed by the local laboratory, and physico-chemical and metals analyses by the central laboratory.

3. Quality of the Service

Condition of tap Continuity How the water is used Home connections (leaking?) Home Watering Watering Water has Hours/day Days/week Domestic Leaks Yes No streets veg.gardens formed pools 1 2 3 4 5 6

Date: ______

Sampler: ______Signature: ______

FORM M-5

FORM TO VERIFY HABITS OF HYGIENE AND PRESENCE OF DISEASES IN THE COMMUNITIES

Community/Annex/Sector ______District ______Province ______CODE______

Habits of Hygiene 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1. Water 1.1 Do you consume chlorinated water? 1.2 Do you store water in clean recipients with a lid? 1.3 Do you draw the stored water out with a jug or a ladle? 1.6 Is the tub clean and in working order? 2. Personal Hygiene 2.1 Are the people in the house clean? 2.2 Hand-washing 2.2.1 Are your hands clean? (check) 2.2.2 Do you wash your hands under the running water? (check) 2.2.3 Do you wash your hands before meals? 2.2.4 Do you use soap or ashes to wash your hands? 2.2.5 Do you wash your hands after using the latrine? 3. Latrines 3.1 Do you have a latrine? 3.2 Is it working? 3.3 Do you all use the latrine? 4. House 4.1 Is the kitchen clean and tidy? 4.2 Are the cooking utensils clean and protected? 4.3 Are the large animals kept outside the house?* 4.4 Absence of fecal waste around the outside of the house? 5. Garbage Disposal 5.1 Do you bury the garbage? 5.2 Other ways of disposing of garbage (not scored) • River • Field • Burning Total

Habits of Hygiene 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 6. Presence of Diseases (past two weeks)

6.1 ADD 6.1.1 Cases of ADD in under-five-year-olds? (Number) 6.1.2 Cases of ADD in over-fives? (Number) 6.2. Skin diseases (SD) 6.2.1 Skin diseases in under-five-year-olds? (Number) 6.2.2 Skin diseases in over-fives? (Number)

* Large animals: cattle, pigs, goats, sheep, horses and mules.

Date:______Name of sampler: ______Signature: ______

FORM M-6

FORM TO VERIFY HABITS OF HYGIENE IN THE SCHOOL POPULATION

Code ______Community/Annex/Sector ______School______District ______Province ______

School Children 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1. Personal Hygiene 1.1 Are the children clean? 1.2 Are they wearing clean clothes? 2. Hand-Washing 2.1 Are their hands clean? (check) 2.2 Do they wash their hands under running water? (check) 2.3 Do they wash their hands before school breakfast? 2.4 Do they use soap or ashes to wash their hands? (check) 2.5 Do they wash their hands after using the latrine? 3. Use of Toilets or Latrines 3.1 Do the children use the toilet or the latrine? 4. School 4.1 Does it have a toilet or latrines? 4.2 Are they working? 4.3 Is the toilet or latrine clean? 4.4 Are the classrooms clean? 4.5 Absence of fecal waste in the vicinity of the school? 5. Garbage Disposal 5.1 Do they bury the garbage? 5.2 Other forms of garbage disposal (not scored) • River • Field • Burning

Total Score Note: In a school population of more than 100 students, the survey is applied to 20%.

Date:______Name of sampler: ______Signature: ______

INSTRUCTIONS ON FILLING OUT THE FORMS

Surveillance of the Quality of Rural Water Supply Services 259

FORM M-1

COMMUNITY REGISTRATION FORM

1. Location Code: Insert the number assigned by the Surveillance Agency to the community, annex, or sector. Community: Indicate the name of the community. Annex/Sector: Indicate whether it is an annex or sector. District: Indicate the district to which the annex or sector belongs. Province: Indicate the province where the district is located. Department: Indicate the department to which the province belongs. Total population: Note the total population of the locality. Number of families: Indicate the number of families living in the community. Health facility for referrals: Note the name of the health facility whose jurisdiction the community comes under.

2. Accessibility

- From: First insert the name of the referral health facility, and in the following lines the answer to TO appearing in the line above. - To: Write the name of the geographic place where there is a change in the type of road or means of transportation. - Distance: Corresponding to the stretch indicated in the row. - Time: Idem. - Type of Road: Indicate which type of road the stretch can be described as: Paved, packed dirt road trail. - Means of Transportation: Indicate how one can travel along that stretch: Vehicle, pack animal, or on foot.

3. Additional Basic Services

- Put an X in the appropriate box. - Telephone: If there is a telephone, note the number. - Radio: If there is radio in the locality, note the radio frequency.

4. Schools

- Mark with an X the type of school. - Others: Indicate any other type(s) of school existing in the locality apart from the three mentioned.

Write the date, and the name of the survey conductor. He/she should sign the form in the space provided.

260 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM M-2

FORM FOR ASSESSING MANAGEMENT AND COVERAGE

1. Location

Code: Insert the number assigned by the Surveillance Agency to the community, annex, or sector. Community: Indicate the name of the community. Annex/Sector: Indicate whether it is an annex or sector. District: Indicate the district to which the annex o sector belongs. Province: Indicate the province where the district is located.

2. Management

2.1 Responsible for Administration of the Water Service

- Mark with an X the institution responsible for administration of the water service. - Duration of position: Indicate the number of years stipulated in the administration bylaws. - How long in office: Indicate the number of years that those responsible for the administration of the water service have been in office.

2.2 Revenues

- In each line indicate in the columns corresponding to home connections or public standpipes, the following data: the amount in Soles paid for the water services; how many months the water payment covers (monthly, quarterly, etc.); and the number of connections existing in the community. - Tariff in force for: Indicate for how many years the water service tariff has been in force.

2.3 Punctuality

- Indicate the percentage of consumers who pay the water tariff punctually.

2.4 Extraordinary Contributions

- Mark with X the appropriate box if the consumers make extraordinary contributions.

2.5 Operation and Maintenance

- Indicate whether the water supply service has a person in charge of operation and maintenance. - Indicate the time spent by the operator attending to the water supply service.

Surveillance of the Quality of Rural Water Supply Services 261

− Full time: Indicate that the operator works the equivalent of a full working day every day of the week. − As required: The operator is required only when there is the need for a specific task to be done. − Part time: The operator works only some hours every day.

2.6 Administrative Costs (monthly)

Administration: Indicate the monthly sum paid, only if one or more members of the Water Board receives payment. Operator: Indicate the monthly amount paid to the operator. Material: Indicate the amount spent during the month on the purchase of chlorine, or for materials used making new connections or repairing the water distribution network.

3. Coverage

− Indicate the number of houses, home connections, public standpipes, and homes not attended by the water supply service. Make sure that the sum of the last three equals the number of houses existing in the locality.

Write the date, and the name of the survey conductor. He/she should sign the form in the space provided.

262 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM M-3

FORM FOR ASSESSING THE SANITARY CONDITION OF THE WATER SUPPLY INFRASTRUCTURE

1. Location

Code: Insert the number assigned by the Surveillance Agency to the community, annex, or sector. Community: Indicate the name of the community. Annex/Sector: Indicate whether it is an annex or sector. District: Indicate the district to which the annex or sector belongs. Province: Indicate the province where the district is located.

2. The Drinking Water System

- Age: Indicate how many years ago the water supply system was built. - Executor: Indicate the institution or organization that built the water supply system. - Operation: Indicate whether the water supply system works continuously or is restricted because of cuts in the supply or lack of water.

3. Type of Supply System

Mark with X the corresponding box.

4. Source

- Indicate whether in time of drought the source is capable of producing more water than the locality needs. This can be observed by seeing how the overflow pipe works at the intake. - Depending on the type of water supply system, use the appropriate groups of questions.

4.1 Intakes and Water Reunion Boxes

- Indicate the number of intakes and water reunion boxes. - For each question about the characteristics of the intakes and water reunion boxes, answer YES or NO as appropriate.

4.2 Deep Well

- Indicate the type of well that is being assessed (drilled or dug), as well as its depth in meters. - For each question about the characteristics of the water well, answer YES or NO as appropriate.

4.3 Filtration Gallery and Water Reunion Boxes

- Indicate the number of water reunion boxes.

Surveillance of the Quality of Rural Water Supply Services 263

- For each question about the characteristics of the filtration gallery and water reunion boxes, answer YES or NO as appropriate.

4.4 Surface Water with Treatment

- Indicate the type of water supply source: Stream (a small water course), lake, lagoon, river, gully . If it is any other type, indicate in the space provided. - Indicate whether the water is supplied to the treatment plant by pumping or by gravity. - For each question about the characteristics of the treatment plant, answer YES or NO as appropriate.

5. Conduction System (conduction line, and air-vents and pressure-relief box in the conduction line)

For each question about the characteristics of the conduction system, answer YES or NO as appropriate.

6. Distribution System (reservoir, feeder main, pressure-relief boxes, distribution network and public standpipes)

For each question about the characteristics of the distribution system, answer YES or NO as appropriate.

7. Chlorination

- Indicate whether the water is chlorinated permanently, sometimes, or whether it is not customary to disinfect the water. - For each question about the characteristics of the chlorination system, answer YES or NO as appropriate.

Write the date and the name of the survey conductor. He/she should sign the form in the space provided.

264 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM M-4

FORM FOR COLLECTING WATER SAMPLES AND ASSESSING SERVICE QUALITY

1. Location

2. Samples

2.1 Distribution network - For each of the homes, fill in the house address and name of the person surveyed. - Time of sampling: Indicate the time the sample was taken. - Chlorine residual: Note the concentration of chlorine residual found in the water of the evaluated home. - Number of sample: Note the number of the sample and of the flask containing the sample which will be sent to the local laboratory for testing.

2.2 Components - Type: Note the name of the structure where the sample was taken, for example, intake, pressure-relief chamber, etc. - Time of sampling: Indicate the time the sample was taken. - Chlorine residual: Note the concentration of chlorine residual found in the water of the evaluated component. - Number of sample: Note the number of the sample and of the flask containing the sample which will be sent to the local laboratory, and the central laboratory if necessary, for testing.

3. Quality of the Service - For each of the homes indicated previously, note the answers regarding continuity, how the water is used, condition of the tap(s) and condition of the home connection. - Continuity: Note the hours per day and the days per week that the household is supplied with water. - How the water is used: Indicate the main use given to the water supplied by the system. - Condition of the tap: Note whether or not the tap is leaking. - Home connections: Note whether in the home connection box the pipe shows signs of leaking and/or whether the box is full of water.

Write the date, and the name of the survey conductor. He/she should sign in the space provided.

Surveillance of the Quality of Rural Water Supply Services 265

FORM M-5

VERIFICATION OF HABITS OF HYGIENE AND PRESENCE OF DISEASES IN THE COMMUNITIES

Community: Indicate the name of the community. Code: Insert the number assigned by the Surveillance Agency to the community, annex, or sector. Annex/Sector: Indicate whether it is an annex or sector. District: Indicate the district to which the annex o sector belongs. Province: Indicate the province where the district is located.

- House: Note the address of the house. - Water: For each question answer YES or NO, as appropriate. - Personal hygiene: For each question answer YES or NO, as appropriate. In item 2.2.3 indicate the number of times they wash their hands each day. - Latrines: For each question answer YES or NO, as appropriate. - House: For each question answer YES or NO, as appropriate. - Garbage disposal: Answer YES or NO, as appropriate. - Presence of diseases: Indicate the number of cases of diarrheal diseases and skin infections that occurred in the house during the previous two weeks.

Write the date, and the name of the survey conductor. He/she should sign the form in the space provided.

266 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM M-6

VERIFICATION OF HABITS OF HYGIENE IN THE SCHOOL POPULATION

School: Indicate the name of the school. Community: Indicate the name of the community. Annex/Sector: Note whether it is an annex or a sector. District: Indicate the district to which the annex or sector belongs. Province: Indicate the province where the district is located. Code: Note the number assigned by the Surveillance Agency to the community, annex or sector.

- Children: Indicate the name and year of studies. - Personal hygiene: For each question answer YES or NO, as appropriate. - Hand-washing: For each question answer YES or NO, as appropriate. In item 2.3 indicate the number of times they wash their hands each day. - Presence of diseases: Indicate the number of cases of diarrheal diseases and skin infections that occurred in the house during the past two weeks. - Latrines: With reference to the latrine(s) existing in the school, for each question answer YES or NO, as appropriate. - Use one column per latrine. - School: For each question answer YES or NO, as appropriate. - Garbage disposal: Answer YES or NO, as appropriate.

Write the date, and the name of the survey conductor. He/she should sign the form in the space provided.

ANNEX 5

SAMPLE COLLECTION AND PRESERVATION, AND REPORTING OF FINDINGS

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1. Introduction

One of the main components of the surveillance of drinking water quality is the evaluation and characterization of the water supplied to the people. Evaluation and characterization of the water are carried out by analyzing the water samples obtained from the supply system.

This Section is concerned with different aspects of the sampling process, and the special care that must be taken from the time the sample is collected up to its arrival at the laboratory. We also include model laboratory analysis reports.

The collection and transportation of samples must comply with the following requisites:

Planning the Sampling

Perform the sampling as frequently as recommended by the Sanitary Authorities.

Sampling Sites

Select the sampling sites so that the samples obtained will be representative of the water flowing through the supply system.

Be Careful

Do not contaminate the water sample while taking the sample or during transportation.

Taking the Sample

Take an adequate volume of the sample in flasks appropriate for the laboratory.

Preservation

Protect the water sample from any significant change in its composition before its analysis.

Identification

Clearly describe the details of the sampling on the cards accompanying the flasks with the water samples.

Packing and transportation

Pack the water samples properly to avoid breakage of the containers or contamination of the contents, and send them as soon as possible to the laboratory for analysis.

270 Guidelines for the Surveillance and Control of Drinking Water Quality

The criteria for taking a sample for bacteriological analysis should take into account the concentration of free chlorine and turbidity as indicated in Figure 1.

TAKE SAMPLE

CHLORINE ANALYSIS

Cl < Cl > 03 03

TURBIDITY ANALYSIS

> 5 UNT < 5 UNT

COLIFORM COLIFORM ANALYSIS NOT ANALYSIS JUSTIFIED

Figure 1. Criteria for Decision on Testing for Coliforms

2. Containers and Volumes

When taking water samples for analysis, care must be taken in a number of aspects, according to the type of sample.

a) Bacteriological

The bottle, jar or flask for bacteriological samples must be sterilizable, preferably of glass, with a wide mouth, a securely closing cap or stopper and capacity of no less than 120 mL.

These sample bottles must be carefully washed and thoroughly rinsed so that no residue remains of the chemical substances used in washing. Before the sterilization process the bottles must be drained of all water; once dry, add 2 or 3 drops of sodium thiosulfate at 10%, then place a strip of kraft paper between the cap and the neck of the bottle to prevent its getting stuck later. Also, in order to preserve it from external contamination and the introduction of foreign matter during handling, transportation and sampling, place a protective kraft paper sleeve over the mouth, tying it in place with a piece of cord or string (see Figure 2).

Surveillance of the Quality of Rural Water Supply Services 271

Once the bottle has been prepared as described above, proceed to sterilize it in a hot air oven at 160 ºC for two hours or by autoclaving it at 121 ºC for 20 minutes.

Figure 2. Sample Bottle b) Physical

The sample containers used in this group of analyses can be plastic (polyethylene or polypropylene) or glass, of half-liter capacity.

These bottles must be washed carefully with a solution of detergent and rinsed with abundant water. Then add a solution of hydrochloric acid 1+1 and rinse again with abundant water. The final rinse is with distilled or de-ionized water. After the final rinse, drain the bottle and put the stopper on. c) Chemical

The sample containers used in this analysis group can be plastic (polyethylene or polypropylene) or glass, of one-liter capacity. The washing procedure is similar to the previous one, except that the cleaning with hydrochloric acid must be even more thorough.

For the type of preservation of the samples, the sample should be divided into two parts. The first part is for the determination of:

- Calcium - Chlorides - Total hardness - Magnesium - Sulfates - Total residual - Fluoride - Nitrate - pH - Turbidity

272 Guidelines for the Surveillance and Control of Drinking Water Quality

The second flask is for the analysis of:

- Aluminum - Zinc - Copper - Iron - Manganese - Arsenic - Cadmium - Chromium - Mercury - Lead

3. Selection of Sampling Sites in the Network

The objective of the sampling is to determine the “quality of the water in the supply system," whether it be in the components or the user’s faucet or at some other outlet of water destined for human consumption.

- Be representative of the supply system as a whole and its principal components. - Represent the quality of the different sources of water supply. The sampling points should be located immediately outside the outlet from the treatment plant or water well. - Represent the conditions of the least favorable places in the system from the point of view of possible contamination. - Be spread evenly throughout the length and breadth of the water supply system. - Consider the presence of the different components (storage tanks and/or pumping chambers). - Take into account the number of inhabitants served by the supply system. - The sampling points are selected according to the type of distribution system, which could be open, closed or mixed. - In open distribution systems, the most representative sampling points are those shown in Figure 3. - Likewise, in closed distribution systems the sampling points to be emphasized are those shown in Figure 4. - Finally, in mixed distribution systems the sampling points are selected as shown in Figure 5.

In addition, the following aspects must be considered:

a) Critical points of the system such as areas with old networks, areas with a history of continual breakage, areas with low pressure, or areas exposed to frequent flooding.

b) Areas with a high population density.

c) Supply points for tank trucks and individual collection.

Surveillance of the Quality of Rural Water Supply Services 273

d) Food industry areas. e) Emergency areas. f) Areas used for recreation or mass meetings.

Figure 3. Sampling Sites in Open Distribution Systems

274 Guidelines for the Surveillance and Control of Drinking Water Quality

Figure 4. Sampling Sites in Closed Distribution Systems

Figure 5. Sampling in Mixed Distribution Systems

Surveillance of the Quality of Rural Water Supply Services 275

4. Sample Collection

General

The collecting or taking of a sample depends on the types of structures or sampling points. These can be classified as follows:

Components Reservoirs Cisterns

Distribution network Home connections (direction connection to the network) Public standpipes

Dug wells

Springs

Procedures

Precautions are taken in keeping with the type of analysis. The procedures can therefore be described as follows:

Bacteriological

a.1 Components (Reservoirs, Cisterns and Home Storage)

Cleaning

Remove any type of residual found around the lid of the component with a brush.

Removal of the Lid

Remove the lid carefully, taking care that no type of residual falls into the component.

Opening of the Sterilized Flask

Untie the string that holds the protecting paper sleeve in place, remove the sleeve and unscrew the top.

276 Guidelines for the Surveillance and Control of Drinking Water Quality

Sterilization

Using a flame lit on a wad of absorbent cotton soaked in alcohol, sterilize the external part of the sample flask.

Taking of the Sample

After the flask has cooled, very carefully submerge it in the mass of water, to a depth of approximately 20 cm.

Replacing the Stopper

Before replacing the stopper, pour off a small amount of water to leave an air space which will facilitate sample shaking (mixing) at the analysis stage.

Then replace the stopper on the flask and cover with the protecting kraft paper sleeve. Tie this in place with the string.

a.2 Distribution Network (Home connections and public standpipes)

Cleaning the Faucet

Remove from the faucet any material adhering to it that could cause splashing. Carefully clean the mouth of the faucet with a clean cloth to remove any dirt or grease.

Washing out the Faucet

Open the faucet to its maximum flow and let the water run for 1-2 minutes.

Sterilization

Before taking the water sample, close the faucet and sterilize it for one minute with the flame from a piece of absorbent cotton soaked in alcohol. As an alternative, a gas flame or a lighter can be used.

Draining the Faucet before Sampling

Open the faucet carefully and allow the water to flow slowly for 1-2 minutes more, at a speed suitable for filling the sample flask easily.

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Opening the Sterilized Flask

Untie the string that is holding the protecting paper sleeve in place, and remove the paper sleeve.

Taking the Sample

Remove the stopper or unscrew the cap and, while holding it in one hand, immediately put the flask under the flow of water and fill it. Leave a small air space to facilitate shaking at the analysis stage.

Sealing the Flask

Replace the stopper on the flask or screw on the cap. Tie the protective paper sleeve in place with the string. a.3 Dug Wells

Placing the Extension

Around the neck of the bottle or flask tie a clean string wound onto a stick.

Opening the Sterilized Flask

Untie the string that holds the protecting paper sleeve in place, take off the sleeve and unscrew the cap.

Sterilization

Using a flame lit on a piece of absorbent cotton soaked in alcohol, sterilize the outside of the sample flask.

Taking the Sample

After the flask has cooled, lower it carefully into the well, slowly unwinding the string until the flask reaches the water. Do not allow the flask to touch the walls of the well. Submerge the flask completely in the water.

Raising the Flask

Once the flask is believed to be full, rewind the string around the stick to raise the flask.

278 Guidelines for the Surveillance and Control of Drinking Water Quality

Replacing the Stopper

Before replacing the stopper, pour out a small amount of water to leave an air space, which will facilitate the shaking of the sample at the analysis stage. Then replace the stopper on the flask. Replace the protecting paper sleeve and tie it in place with the string.

a.4 Springs

For collecting water samples from springs, follow the methods described for components or for dug wells. The sampling procedure will depend on the facilities available at the sampling site.

a.5 Water Courses

Opening the Sterilized Flask

Untie the string that holds the protecting paper sleeve in place, take off the sleeve and unscrew the cap.

Taking the Sample

Holding the flask by the lower part, submerge it to a depth of 20 cm with the mouth slightly upward. If there is a current of water, the mouth of the flask should face the flow of water.

Replacing the Stopper

Before replacing the stopper, pour out a small amount of water to leave a small air space which will facilitate the shaking of the sample at the analysis stage. Then replace the stopper on the flask. Replace the protecting paper sleeve and tie it in place with the string.

Chemical

In these specific cases, the same care must be taken during the sampling as that indicated for the bacteriological analyses.

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5. Identification

Once the sample has been taken, the flask must be labeled with the code number of the locality, the date of sampling and the number of the sample. The basic data must be recorded on form M-4 shown in Annex 4.

Care should be taken that the code number of the sample that appears on the flask is the same as is written on form M-4.

6. Preservation

It is impossible to recommend the exact time between sample collection and analysis. However, the following general points should be taken into account.

Chemical

This group of analyses should be divided into two parts, the first comprising calcium, chlorides, total hardness, magnesium, sulfates, total residuals, fluoride, nitrate, pH and turbidity, which require only refrigeration and a maximum period of seven days between sample collection and analysis.

The second group is represented by aluminum, zinc, copper, iron, manganese, arsenic, cadmium, chromium, mercury and lead. For these analyses special preservation is called for, necessitating the addition of 5 mL of concentrated nitric acid per liter of sample, and the time between sample collection and analysis can be up to three months. Table 1 shows the types of preservatives to be used in the conservation of water samples.

Table 1. Containers and Type of Preservatives by Group of Determinations

Type of Container Determination Preservative and Volume* Bacteriological G 120 mL Refrigeration to 4 °C Physical Non Metal P,G 500 mL Refrigeration to 4 °C Metal P,G 500 mL Nitric acid 5 mL/L Chemical Non Metal P,G 500 mL Refrigeration to 4 °C Metal P,G 1,000 mL Nitric acid 5 mL/L * G = Glass P = Plastic

280 Guidelines for the Surveillance and Control of Drinking Water Quality

7. Packing and Transportation

The samples sent to the Regional Laboratory or Central Laboratory should be adequately packed in strong cases.

8. Reporting the Findings

Models of forms to be used by the local and central laboratories to report the analytical test findings are shown in Forms L-1 and L-2.

Surveillance of the Quality of Rural Water Supply Services 281

FORM L-1

MINISTRY OF HEALTH EXECUTIVE OFFICE OF ENVIRONMENTAL HEALTH - CUZCO SANBASUR PROJECT

REPORT ON ANALYSIS OF WATER SAMPLES Peripheral Laboratory

ORIGIN CODE ______Town ______District ______Province ______Department______

SAMPLING

Date of sampling: ______Date and time of entry to laboratory: ______Date and time of analysis:______Sampled by: ______

RESULTS

Distribution Network Coliforms Chlorine Laboratory Address Time of Turbidity UFC/100 mL House residual code sampling (NTU) Thermo- (mg/L) Total tolerant 1 2 3 4 5 6 Components Coliforms Chlorine Laboratory Type Time of Turbidity UFC/100 mL Order residual code sampling (NTU) Total Thermo- (mg/L) tolerant 1 2 3

Date: ______

Analyst: ______Signature______

282 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM L-2 MINISTRY OF HEALTH EXECUTIVE OFFICE OF ENVIRONMENTAL HEALTH - CUZCO SANBASUR PROJECT REPORT ON PHYSICO-CHEMICAL ANALYSIS OF WATER SAMPLE Central Laboratory

ORIGIN CODE ______Sampling site ______Town ______District______Province______Department______

SAMPLING Date and time of sampling:______Date and time of entry to laboratory: ______Date of beginning of analysis:______Sampled by: ______

RESULTS Parameter Expression Concentration Turbidity NTU pH Unit of pH Aluminum mg/L as Al Calcium mg/L as Ca Zinc mg/L as Zn Chloride mg/L as Cl Copper mg/L as Cu

Total hardness mg/L as CaCO3 Iron mg/L as Fe Magnesium mg/L as Mg Manganese mg/L as Mn = Sulfate mg/L as SO4 Total residual mg/L Arsenic mg/L as As Cadmium mg/L as Cd Chromium mg/L as Cr Fluoride mg/L as F Mercury mg/L as Hg - Nitrate mg/L as NO3 Lead mg/L as Pb

Date: ______

Analyst: ______Signature:______

ANNEX 6

TRAINING PROGRAM

Surveillance of the Quality of Rural Water Supply Services 285

Program of the Training Course for Technicians in Sanitation

Time Topic Type of Session 8:00 - 8:30 Registration Presentation of participants and 8:30 – 8:45 Group dynamics expectations 8:45 – 9:15 Water and health Presentation Ideas on control and surveillance of 9:15 – 10:00 Presentation drinking water quality

10:00 – 10:15 Break 10:15 – 10:45 Drinking water quality standards Presentation 10:45 – 11:30 Characteristics of water supply services Presentation 11:30 – 12:30 Sanitary inspection Presentation

12:30 – 13:30 Lunch 13:30 – 14:00 Sanitary inspection Presentation Techniques for sample collection and 14:00 – 14:45 Presentation preservation 14:45 – 15:30 Field analysis Practical work

15:30 – 15:45 Break 15:45 – 16:15 Interpretation and analysis of findings Presentation 16:15 – 16:45 Identification of corrective measures Workshop 16:45 – 17:30 Roundtable discussion Roundtable discussion 17:30 – 17:45 Evaluation of the course-workshop Evaluation 17:45 – 18:00 Closing ceremony

ANNEX 7

INFORMATION FLOW

Surveillance of the Quality of Rural Water Supply Services 289

1. Introduction

The assessment of the water supply service includes the evaluation of water quality, the sanitary inspection, examination of service management, the community’s habits of hygiene, and the prevalence of water-born diseases, and the findings it produces must flow toward the pertinent higher levels to rate overall service quality and identify the corrective measures necessary to improve the water supply service for the benefit of the users’ health.

To meet the goal of surveillance of drinking water quality it is necessary to identify the agencies involved, the responsibilities of each participant, and the routes the information must follow through the whole administrative system of the health service in the Cuzco Health Region until it arrives at the agency responsible for the surveillance of water quality.

2. Reporting the Findings

The results of the analyses of water samples performed in the communities, district laboratories and central laboratory, as well as the information relating to sanitary inspection, system management, prevalent diseases, and habits of hygiene, must be reported to the pertinent levels where they should be carefully processed to determine, for each community evaluated, the quality of the drinking water, the quality of the existing water supply service, and the principal defects identified, as well as the kind of action required to improve the quality of the service.

At first, until responsibilities are assigned to other agents involved in the follow-up and supervision of the community water supply systems, the information to be sent to the next tier up by each of the agents belonging to the decentralized health institutions is as follows:

Sanitary inspector: Sanitary Inspection Report. (Annex 9). Form M-1.- “Community Registration” (Annex 4). Form M-2.- “Assessment of Management and Coverage” (Annex 4). Form M-3.- “Assessment of the Sanitary Condition of the Water Supply Infrastructure” (Annex 4). Form M-4.- “Water Sample Collection and Assessment of Service Quality” (Annex 4). Form M-5.- “Verification of Habits of Hygiene and Presence of Diseases in the Community” (Annex 4). Form M-6.- “Verification of Habits of Hygiene in the School Population” (Annex 4).

Peripheral Laboratory: Form L-1.- “Report on Analysis of Water Samples” (Table 2 Annex 5).

Central Laboratory: Form L-2.- “Report on Physico-Chemical Analysis of Water Sample” (Form L-2 in Annex 5).

290 Guidelines for the Surveillance and Control of Drinking Water Quality

3. Planning

Since the Health personnel have to visit each community once a month, and since this visit can require a sanitary inspection, management assessment and evaluation of habits of hygiene, as well as water analyses on site, in the local laboratory, and/or the central laboratory, it is indispensable that the agency responsible for surveillance of water quality, together with the laboratory, plan all these activities, taking special care with respect to the scheduling of physico- chemical and metals analyses in order to prevent unnecessary congestion in the central laboratory.

4. Information Flow

The findings of the evaluation of the water quality, condition of the infrastructure of the water supply system, system management, habits of hygiene, and prevalence of diseases must be reported to the community Water Board and authorities, so that remedial measures may be introduced promptly. They must also be reported to the Surveillance Agency for the latter to perform follow-up on the community's compliance with the report recommendations, to ensure an improvement in the quality of the drinking water.

The Surveillance Agency, for its part, periodically summarizes all the information relating to water quality and forwards it to the pertinent authorities. These reporting processes are carried out on an ongoing basis, fed by an efficient information system, at the regional and national level. See Figure 1 for an information and notification flow chart.

Surveillance of the Quality of Rural Water Supply Services 291

Coordinating authority

Priority Annual Report Information National database DIGESA

resources Transfer of Priority

investments

Feedback

Annual Report

Annual Report Regional database Health network CTAR

report Feedback resources Transfer of

investments Summary of Prioritization of t Sub-Regional Micro health Annual Repor Regional database network municipality

Report Feedback resources Transfer of investments Prioritization of Data Report District Local file Health facility municipality

Notification

support Report

Request for

Sanitary Community inspector Report authority actions

Corrective up

Report Administrative Board of Follow- Sanitation Services

Inspection

Water supply system

Figure 1. Information Flow Surveillance of the Quality of the Water Supply Services

292 Guidelines for the Surveillance and Control of Drinking Water Quality

5. Notification and Follow-Up

The health personnel of the Health Post or Health Center responsible for assessing the condition of administrative management, water quality, condition of the supply system, hygiene and prevalent diseases must notify the Water Board of the inspected community, as well as the community authority, of the results of their general observations, together with a list of the remedial measures necessary to improve the quality of the water and of the water supply service.

The notification to the Water Board is effected using Form N-1 the first time and Form N-2 in the event that the first notification was not heeded.

Form N-1 consists of two parts, the first listing analytical results (coliforms, turbidity and free chlorine) from each one of the points evaluated that do not meet the Health Authority standards, and the second listing any physical faults or defects of the water supply system, problems in the administrative management of the supply service, shortcomings in habits of hygiene, and the level of diseases. The purpose of this form is to urge the Water Board to schedule the actions required to correct the shortcomings or defects indicated in the report or to request any support they may need in this reference from the pertinent authorities.

Form N-2 is used when the Water Board is found to have taken no action on the first notification or when, in spite of corrective measures, the defects or shortcomings are still present.

Notifications N-1 and N-2 are made out in triplicate and distributed in the following way:

File of the health institution that made the observations 1 copy Water Board of the evaluated community 1 copy Executive Office of Environmental Health 1 copy

The health personnel of the Health Post or Center responsible for the evaluations of the water supply systems should submit a quarterly report to the next higher level on the actions carried out in the preceding quarter, using Forms S-1 and S-2. These forms, filled out for each community, are used to note everything related to the collection of water samples, notifications and principal defects in the water supply system, as well as observations on management, habits of hygiene and the number of diseases detected.

Form S-1 should be made out in triplicate and distributed in the following way:

File of the health institution that made the observations 1 copy Immediately superior Health Authority 1 copy Executive Office of Environmental Health 1 copy

Surveillance of the Quality of Rural Water Supply Services 293

FORM N-1

The Chairperson Water Board of the Community of ...... …………..

Dear Sir or Madam:

Re: Surveillance of the Quality of Drinking Water In the evaluation carried out on ...... (date) of the water supply service in your community it was found that the quality of the water service does not comply with current sanitary regulations. To this effect, the results of the water analyses were as follows:

Sampling point Coliforms/100 mL Turbidity (NTU) Free Chlorine (mg/L) ...... The accepted values for each of the indicated parameters are: Coliforms/100 mL 0 Turbidity Less than 5 NTU Free chlorine Greater than 0.3 mg/L

Likewise, the following defects have been detected in the water supply system. These defects will have to be corrected in order to improve the quality of the water service......

With regard to administrative management, habits of hygiene, and diseases associated with bad water handling, the following aspects have been detected: ......

Trusting that the pertinent corrective measures will be taken as soon as possible, we remain,

Sincerely,

...... Health Technician Local Director cc: File

294 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM N-2

The Chairperson Water Board of the Community of...... …………..

Re: Surveillance of the Quality of Drinking Water

Dear Sir or Madam:

On (date)…...... we sent you a first (second) notification of the following observations resulting from our inspection of the water supply system that you administer:

......

Since ………….. days have passed without any corrective action having been taken, we repeat our observations for the second (third) time so that the corresponding remedial measures can be adopted to safeguard the health of the users of the water supply service.

Sincerely,

...... Health Technician Local Director

cc: File

FORM S-1

SUMMARY OF ACTIVITIES CARRIED OUT DURING THE QUARTER

Health Post ...... Quarter ...... Year...... Date of Report...... Made By ……......

Community Reason Notification Water quality Water quality Public Name Code Pressure Distribution No. Date Coliforms Turbidity Chlorine Intake Conduction Reservoir Standpipes/ Chamber Network connections

FORM S-2

SUMMARY OF ACTIVITIES CARRIED OUT DURING THE QUARTER

Health Post ...... Quarter ...... Year...... Date of Report...... Made By ……......

Community Reason

Notification Name Code Management Habits of Hygiene Diseases No. Date

ANNEX 8

PLACES TO BE EVALUATED

Surveillance of the Quality of Rural Water Supply Services 299

Table 1. Water Supply System. SANBASUR Project

N.º N.º N.º Community Province District Water Source Benef. ACOMAYO 1 15 REHAB.KUÑUTAMBO Acomayo Rondocán groundwater 600 2 16 REHAB.RONDOCÁN Acomayo Rondocán groundwater 582 3 17 SAN JUAN DE QUIHUARES Acomayo Rondocán groundwater 630 4 18 REHAB. YARCACUNCA Acomayo Rondocán groundwater 570 5 41 PAROCCOCHA Acomayo Rondocán groundwater 180 6 42 HUAQUY PARARA Acomayo Rondocán groundwater 132 CALCA 1 22 SAYHUA-SECTOR QUEBRADA Calca Lamay groundwater 312 2 32 POQUES Calca Lamay groundwater 324 3 48 SAYHUA Calca Lamay groundwater 155 4 49 PAMPAYPATA Calca Lamay groundwater 120 5 72 HUANCCO Calca Lamay groundwater 245 Huancco sector 1 Calca Lamay groundwater 130 Huancco sector 2 Calca Lamay groundwater 115 6 151 COCHAYOC CC CACHIN Calca Lares groundwater 220

7 152 MAUCAU CC PAMPACORRAL Calca Lares groundwater 190

8 153 CONCEVIDAYOC Calca Yanatile groundwater 160 9 154 MUYUPAY Calca Yanatile groundwater 175 10 160 URCO (REHAB.) Calca Calca groundwater 300 11 162 DESAGÜE CHANCAMAYO Calca Calca groundwater 290 CHUMBIVILCAS 1 1 HUAÑACAHUA Chumbivilcas Quiñota groundwater 145 2 2 MATARA ATTA PALLPA Chumbivilcas Quiñota groundwater 195 3 3 ALQA VICTORIA Chumbivilcas Velille groundwater 222 4 4 AÑAHUICHI Chumbivilcas Chamaca groundwater 252 5 5 UCHUCCARCO Chumbivilcas Chamaca groundwater 504 6 6 AYACCASI Chumbivilcas Velille groundwater 258 7 7 CHAMACA Chumbivilcas Chamaca groundwater 895 8 11 QUIÑOTA Chumbivilcas Quiñota groundwater 615 9 19 CCORCAYOC ATTA PALLPA Chumbivilcas Quiñota groundwater 420 SECTOR CENTRO ATTA 10 20 Chumbivilcas Quiñota 255 PALLPA 11 21 ALLPA ORCUNA ATTA PALLPA Chumbivilcas Quiñota groundwater 180 12 29 CHACARAYA Chumbivilcas Llusco groundwater 390 Chacaraya sector 1 Chumbivilcas Llusco groundwater 220 Chacaraya sector 2 Chumbivilcas Llusco groundwater 170 13 30 CHALLA CHALLA Chumbivilcas Llusco groundwater 165 14 31 TACLLAPAMPA Chumbivilcas Velille groundwater 135 15 33 PAMPALLACTA Chumbivilcas Llusco groundwater 150 16 43 KUTUTO Chumbivilcas Llusco groundwater 320 17 44 LLUSCO Chumbivilcas Llusco groundwater 995 18 45 MOSCCO Chumbivilcas Santo Tomás groundwater 260 19 46 VELILLE Chumbivilcas Velille groundwater 650 Velille sector 1 Chumbivilcas Velille groundwater 400 Velille sector 2 Chumbivilcas Velille groundwater 250

300 Guidelines for the Surveillance and Control of Drinking Water Quality

N.º N.º N.º Community Province District Water Source Benef. 20 47 CONDES PULPERA Chumbivilcas Santo Tomás groundwater 1,050 21 53 CCACHO Chumbivilcas Chamaca groundwater 240 22 54 QUELLOMARCA Chumbivilcas Chamaca groundwater 220 23 79 OCRA-POROHUANI Chumbivilcas Llusco groundwater 125 Ocra sector 1 Chumbivilcas Llusco groundwater 60 Porohuani sector 1 Chumbivilcas Llusco groundwater 65 24 80 CAPILLANIYOC Chumbivilcas Llusco groundwater 170 25 86 CHIRIPA Chumbivilcas Capacmarca groundwater 110 26 87 QANTUTA Chumbivilcas Colquemarca groundwater 310 Qantuta sector 1 Chumbivilcas Colquemarca groundwater 220 Qantuta sector 2 Chumbivilcas Colquemarca groundwater 90 27 88 TOMAPARADA Chumbivilcas Colquemarca groundwater 165 28 89 HUISURAY Chumbivilcas Colquemarca groundwater 145 29 90 EL PORVENIR Chumbivilcas Velille groundwater 315 30 91 LIMAMAYO Chumbivilcas Chamaca groundwater 195 Limamayo sector Chumbivilcas Chamaca groundwater 100 Limamayo sector Chumbivilcas Chamaca groundwater 95 31 92 AMPLIACION VELILLE Chumbivilcas Velille groundwater 1,750 Velille sector 1 Chumbivilcas Velille groundwater 1,000 Velille sector 2 Chumbivilcas Velille groundwater 750 32 96 PORCHON Chumbivilcas Santo Tomás groundwater 155 33 97 CHULLUNQUIA RICRAYOC Chumbivilcas Santo Tomás groundwater 180 Chullunquia Chumbivilcas Santo Tomás groundwater 90 Ricrayoc Chumbivilcas Santo Tomás groundwater 90 34 98 HUAYLLAPATA Chumbivilcas Santo Tomás groundwater 385 35 99 TUNYO Chumbivilcas Quiñota groundwater 180 36 103 ANQOQALA Chumbivilcas Velille groundwater 275 37 116 COLLPA- ASSIAJASI Chumbivilcas Llusco groundwater 330 Collpa Chumbivilcas Llusco groundwater 115 Assiajashi Chumbivilcas Llusco groundwater 215 38 117 PERCATUYO Chumbivilcas Llusco groundwater 280 39 118 YANQUE Chumbivilcas Capacmarca groundwater 520 40 120 CENTRO INGATA Chumbivilcas Chamaca groundwater 250 41 124 PUMAPUJIO TAWAY Chumbivilcas Capacmarca groundwater 225 HUANCALLO Pumapujio sector 1 Chumbivilcas Capacmarca groundwater 110 Pumapujio sector 2 Chumbivilcas Capacmarca groundwater 115 42 125 UCHUCARCO-FUNDICIÓN Chumbivilcas Chamaca groundwater 180 43 127 COCHAPATA-CUCHINCHA- Chumbivilcas Quiñota groundwater 145 YURAQAQA 44 130 LLOQUETA- CHALANSILLO Chumbivilcas Quiñota groundwater 160 Loqueta Chumbivilcas Quiñota groundwater 100 Chalansillo Chumbivilcas Quiñota groundwater 60 45 150 AMPO Chumbivilcas Colquemarca groundwater 245 Ampo sector 1 Chumbivilcas Colquemarca groundwater 120 Ampo sector 2 Chumbivilcas Colquemarca groundwater 125

LA CONVENCIÓN 1 133 CHAHUARES La Convención Echarate groundwater 295 Chahuares sector 1 La Convención Echarate groundwater 220 Chahuares sector 2 La Convención Echarate groundwater 45 Chahuares sector 3 La Convención Echarate groundwater 20

Surveillance of the Quality of Rural Water Supply Services 301

N.º N.º N.º Community Province District Water Source Benef. 2 134 HUAYANAY La Convención Santa Ana groundwater 900 Huayanay sector 1 La Convención Santa Ana groundwater 500 Huayanay sector 2 La Convención Santa Ana groundwater 400 3 135 VERSALLES La Convención Maranura groundwater 175 4 136 SANTUATO La Convención Echarate groundwater 220 Santuato sector 1 La Convención Echarate groundwater 190 Santuato sector 2 La Convención Echarate groundwater 30 5 137 CHAUPIMAYO La Convención Echarate groundwater 225 6 138 CHIRUMBIA La Convención Quellouno groundwater 200 7 139 ARAYPALLPA La Convención Colcha groundwater 385 8 141 SANTUSAIRES La Convención Quellouno groundwater 180 9 143 MASAPATA La Convención Santa Ana groundwater 125 10 144 LLUYCHO La Convención Maranura groundwater 125 11 156 CHOQUELLOHUANCO La Convención Huayopata groundwater 235 Choquellohuanco sector 1 La Convención Huayopata groundwater 110 Choquellohuanco sector 2 La Convención Huayopata groundwater 125 12 157 JUAN VELASCO La Convención Huayopata groundwater 325 13 158 SAN LORENZO La Convención Ocobamba groundwater 290

PARURO 1 8 SAN JUAN DE TARAY Paruro Yaurisque groundwater 240 2 9 HACCA Paruro Omacha groundwater 510 3 10 KARUSPAMPA Paruro Paccarectambo groundwater 264 4 12 CCAPI Paruro Ccapi groundwater 810 5 13 COYABAMBA Paruro Ccapi groundwater 1,080 6 14 PACLLA Paruro Omacha groundwater 450 Sector 1 Paclla Paruro Omacha groundwater 200 Sector 1 Paclla Paruro Omacha groundwater 150 Sector 1 Paclla Paruro Omacha groundwater 100 7 39 SUTICC PUNA Paruro Paruro groundwater 179 8 40 PUCA PUCA Paruro Paruro groundwater 115 9 50 CHIFYA Paruro Huanoquite groundwater 250 10 51 TOCTOHUAYLLA Paruro Huanoquite groundwater 200 11 52 YAURISQUE Paruro Yaurisque groundwater 610 12 59 CHAPINA Paruro Omacha groundwater 130 13 60 OSCOLLOPATA Paruro Omacha groundwater 300 14 61 TAHUI Paruro Omacha groundwater 195 15 62 TAUCABAMBA Paruro Ccapi groundwater 91 16 63 PARCCO Paruro Ccapi groundwater 189 17 74 QOSQOITE Paruro Ccapi groundwater 330 18 81 PERCAJATA Paruro Omacha groundwater 230 19 82 LEQEUCO-RIO BRANCO - Paruro Omacha groundwater 370 HATUNCACHI Lequeco sector 1 Paruro Omacha groundwater 300 Lequeco sector 2 Paruro Omacha groundwater 70 20 83 OMACHA Paruro Omacha groundwater 375 21 93 VISTA ALEGRE Paruro Ccapi groundwater 155 22 94 UCHUCO - QUEHUAYLLO Paruro Ccapi groundwater 180 Uchuco Paruro Ccapi groundwater 90 Quehuayllo Paruro Ccapi groundwater 90 23 95 CHOCHO Paruro Ccapi groundwater 95 24 100 PARCCO Paruro Accha groundwater 385 25 101 COCHAPATA Paruro Yaurisque groundwater 325

302 Guidelines for the Surveillance and Control of Drinking Water Quality

N.º N.º N.º Community Province District Water Source Benef. 26 102 UYLLUMPA Paruro Ccapi groundwater 150 27 107 PICHACA Paruro Omacha groundwater 200 28 108 ANTAYAJE Paruro Omacha groundwater 355 29 114 POMATE Paruro Yaurisque groundwater 325 Pomate sector 1 Paruro Yaurisque groundwater 80 Pomate sector 2 Paruro Yaurisque groundwater 245 30 122 COLCHA Paruro Colcha groundwater 450 31 123 PAMPACUCHO Paruro Colcha groundwater 250 32 129 SAYHUACALLA Paruro Yaurisque groundwater 175 33 131 HAYA- HUYAYHUI Paruro Accha groundwater 330 Haya sector 1 Paruro Accha groundwater 80 Haya sector 2 Paruro Accha groundwater 250 34 140 COCHIRUHUAY Paruro Colcha groundwater 575 Cochiruhuay sector 1 Paruro Colcha groundwater 200 Cochiruhuay sector 2 Paruro Colcha groundwater 375 35 145 UMASHUAYLLA- Paruro Omacha groundwater 190 ANCASCOCHA Umashuaylla sector 1 Paruro Omacha groundwater 100 Ancascocha sector 1 Paruro Omacha groundwater 90 36 159 RANRACASA Paruro Yaurisque groundwater 415 37 161 DESAGÜE CCAPI Paruro Paruro groundwater 720

CANCHIS 1 71 JUCUYRE Canchis Combapata groundwater 245

QUISPICANCHI 1 28 HUARA HUARA Quispicanchi Ccatcca groundwater 85 2 75 PACCHANTA SECTOR 1 Quispicanchi Ocongate groundwater 220 Pacchanta sector 1 Quispicanchi Ocongate groundwater 160 Pacchanta sector 2 Quispicanchi Ocongate groundwater 60 3 76 PAMPACANCHA Quispicanchi Ocongate groundwater 285 Pampacancha sector 1 Quispicanchi Ocongate groundwater 200 Pampacancha sector 2 Quispicanchi Ocongate groundwater 85 4 77 TAYANCANI Quispicanchi Carhuayo groundwater 230 Tayancani sector 1 Quispicanchi Carhuayo groundwater 100 Tayancani sector 2 Quispicanchi Carhuayo groundwater 100 Tayancani Others Quispicanchi Carhuayo groundwater 30 5 78 CONCHOPATA CORICOCHA Quispicanchi Quiquijana groundwater 325 Conchopata sector 1 Quispicanchi Quiquijana groundwater 195 Conchopata sector 2 Quispicanchi Quiquijana groundwater 130 6 84 PAMPAQUEHUAR Quispicanchi Urcos groundwater 880 7 85 PATAQUEHUAR Quispicanchi Urcos groundwater 275 8 104 WACWA LAGUNA Quispicanchi Quiquijana groundwater 410 Wacwa sector 1 Quispicanchi Quiquijana groundwater 245 Wacwa sector 2 Quispicanchi Quiquijana groundwater 165 9 105 MARCANI QOÑAMURO Quispicanchi Urcos groundwater 300 10 106 HUAYLLABAMBA Quispicanchi Ccatca groundwater 175 11 109 ALTO SERRANUYOC Quispicanchi Ccatca groundwater 175 12 110 ANTALLACTA Quispicanchi Quiquijana groundwater 450 13 111 CAURI Quispicanchi Ccatca groundwater 1,030 14 112 CHECACHIMPA Quispicanchi Ocongate groundwater 585 15 113 QENPORAY Quispicanchi Quiquijana groundwater 125

Surveillance of the Quality of Rural Water Supply Services 303

N.º N.º N.º Community Province District Water Source Benef. 16 115 HUASACMAYO Quispicanchi Quiquijana groundwater 650 17 119 HUACARPIÑAYANAMA Quispicanchi Ocongate groundwater 230 18 121 CHURUBAMBA Quispicanchi Andahuaylillas groundwater 300 19 126 KUCHIRUMI Quispicanchi Quiquijana groundwater 250 Kuchirumi sector 1 Quispicanchi Quiquijana groundwater 150 Kuchirumi sector 2 Quispicanchi Quiquijana groundwater 100 20 128 CHUCLLUHUIRE Quispicanchi Carhuayo groundwater 170 Chuclluhuire sector 1 Quispicanchi Carhuayo groundwater 100 Chuclluhuire sector 2 Quispicanchi Carhuayo groundwater 70 21 132 YURACMAYO Quispicanchi Ccatca groundwater 350 22 142 DESAGUE ATAPATA Quispicanchi Ccatca groundwater 250 23 147 PACCHA Y SAÑO Quispicanchi Cusipata groundwater 280 Paccha y Saño Quispicanchi Cusipata groundwater 140 Saño Quispicanchi Cusipata groundwater 140 24 148 ACOCUNCA Quispicanchi Ocongate groundwater 365 25 149 PHINAY PHUYUCUNCA Quispicanchi Huaro groundwater 315 Phiñay sector 1 Quispicanchi Huaro groundwater 200 Phiñay sector 2 Quispicanchi Huaro groundwater 115 26 155 SULLUMAYO Quispicanchi Huaro groundwater 265 Sullumayo sector 1 Quispicanchi Huaro groundwater 200 Sullumayo sector 2 Quispicanchi Huaro groundwater 65 27 23 QOÑAMURO Quispicanchi Ocongate groundwater 290 28 24 SUMANA Quispicanchi Ccarhuayo groundwater 200 29 25 IPACUNA Quispicanchi Urcos groundwater 200 30 26 CULLY Quispicanchi Urcos groundwater 180 31 27 CCOPI Quispicanchi Ccatcca groundwater 480 32 34 PALLPACALLA Quispicanchi Huaro groundwater 180 33 35 PUCA PUCA Quispicanchi Andahuaylillas groundwater 115 34 36 MANCCO Quispicanchi Andahuaylillas groundwater 195 35 37 PAMPACHULLA Quispicanchi Urcos groundwater 1,050 Pampachulla sector 1 Quispicanchi Urcos groundwater 800 Pampachulla sector 2 Quispicanchi Urcos groundwater 250 36 38 PUCA RUMI Quispicanchi Ocongate groundwater 475 37 55 LAURAMARCA Quispicanchi Ocongate groundwater 350 Lauramarca sector 1 Quispicanchi Ocongate groundwater 50 Lauramarca sector 2 Quispicanchi Ocongate groundwater 300 38 56 HUACATINCO Quispicanchi Ocongate groundwater 645 Huacatinco sector 1 Quispicanchi Ocongate groundwater 300 Huacatinco sector 2 Quispicanchi Ocongate groundwater 140 Huacatinco sector 3 Quispicanchi Ocongate groundwater 100 Huacatinco sector 4 Quispicanchi Ocongate groundwater 105 39 57 MOLLEBAMBA Quispicanchi Urcos groundwater 900 40 58 UMUTU Quispicanchi Urcos groundwater 700 Umuto sector 1 Quispicanchi Urcos groundwater 420 Umuto sector 2 Quispicanchi Urcos groundwater 380 41 64 PARCOCALLA Quispicanchi Carhuayo groundwater 525 42 65 QUEROCHIMPA Quispicanchi Carhuayo groundwater 525 43 66 URPAY Quispicanchi Huaro groundwater 775 44 67 ARAHUARA Quispicanchi Huaro groundwater 125 45 68 ATAPATA Quispicanchi Catca groundwater 350 46 69 PUMAORCCO Quispicanchi Catca groundwater 220 47 70 COLLPAMAYO-UMUTO Quispicanchi Urcos groundwater 300 48 73 AQOCANCHA/LLAULLIWAYOC Quispicanchi Quiquijana groundwater 275

ANNEX 9

DETERMINATION OF NUMBER OF SAMPLES

Surveillance of the Quality of Rural Water Supply Services 307

1. Scope

The proposal of the Surveillance Program is to carry out surveillance of water quality of the water supply services constructed by the SANBASUR Project, numbering 157 administrations and 203 water supply systems in the year 2000. The construction of 90 additional systems is planned for the years 2001-2003, giving a total of 293 water supply systems by the year 2003, spread over the seven provinces of the department of Cuzco.

The water supply systems in the rural communities consist of different operations or unit components such as: intake, conduction line, storage, feeder main, pressure-relief chambers, distribution network, and finally, home connections. With respect to procuring information to assess service quality, the following factors are taken into consideration: drinking water quality, the amount consumed, continuity of the service, the coverage of the distribution network, and the cost of the water supply service.

With regard to the responsibilities and activities of the central and local laboratories of DESA-Cuzco working on the evaluation of water quality in compliance with the Program for the Surveillance of Drinking Water, they include the following:

a) Evaluation and implementation of the central laboratory and the local laboratories. b) Establishment of the sampling system and execution of the sampling program to evaluate the quality of the water supplied. c) Execution of the Sampling Program and analysis of the water samples.

2. Work Plan

Figure 1 shows the work plan to be applied for the evaluation of drinking water quality.

3. Number and Frequency of Samples

To ensure that a water supply system is meeting quality standards, it is important that water samples be tested regularly in order to detect and clear up any doubts about the presence of organisms indicating contamination or about the physical-chemical quality. In any case the frequency of sampling both of the components of the supply system and of the distribution system is directly proportional to the density of the population served. In Annex 3 the sampling frequencies are indicated, as well as the number of samples to be taken by each group respectively.

The total number of analyses required to be carried out in the three years planned for control and surveillance of drinking water quality for the rural populations of the Cuzco Health Region is summarized in the following table.

308 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 1. Analyses Required in Three Years Planned for Control and Surveillance of Drinking Water Quality

CHARACTERISTICS YEAR 2000/base 2001 2002 2003 SYSTEMS (totals) 203 233 263 293 SYSTEMS (to evaluate) 85 263 293 DETERMINATIONS Coliforms 3,066 1,284 3,973 4,426 Turbidity/pH 6,132 2,568 7,945 8,851 Chlorine residual 6,132 2,568 7,945 8,851 Physical-chemical 201 85 261 291 Metals 101 43 131 146

4. Timeframe for Surveillance of Water Systems (203 Systems Constructed by DIGESA- COSUDE)

Table 2. Chronogram of Activities

ACTIVITIES 2001 2002 2003 1 2 3 4 1 2 3 4 1 2 3 4 Checking of books and statistics, gathering of the information needed for drawing up the Program. x Acomayo (6 systems) x x x x x x x x x x Calca (11 systems) x x x x x x x x x x Canchis (1 system) x x x x x x x x x x Chumbivilcas (44 systems) x x x x x x x x x x La Convención (18 systems) x x x x x x x x x x Paruro (45 systems) x x x x x x x x x x Quispicanchi (65 systems) x x x x x x x x x x Drawing up the baseline x x x x x x x x x x Preliminary reports x x x Final Report x

5. Budget

In determining the cost per year of performing the analyses, the following values have been considered: Coliforms S/. 3.63 Turbidity/pH * S/. 0.25

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Chlorine residual * S/. 0.25 Physical-chemical S/. 8.77 Metals ** S/. 10.00

* Cost of equipment not included ** Cost of transportation to Lima for analysis by DIGESA

The cost of carrying out the analyses for the surveillance and for determining the base line of new interventions in the year 2001 amounts to seven thousand eight hundred Nuevos Soles (S/. 7,800.00), of which seven thousand one hundred twenty Nuevos Soles (S/. 7,120.00) corresponds to surveillance and six hundred eighty Nuevos Soles (S/. 680.00) to the baseline. For 2002 and 2003, investment could be in the region of S/. 22,000.00 and S/. 24,500.00 respectively. These costs are only for the consumption of chemicals and culture media and do not include replacement of glassware, purchase or repair of equipment or instruments, nor the labor for performing the analyses and collecting samples.

Table 3. Cost of Analyses (in Nuevos Soles)

Surveillance Year 2001/base 2001 2002 2003 Systems (total) 203 233 263 293 Systems (to be assessed) 85 263 293 Determinations Coliforms 11.129,58 4.660,92 14.421,99 16.066,38 Turbidity/pH 1.533,00 642,00 1.986,25 2.212,75 Chlorine residual 1.533,00 642,00 1.986,25 2.212,75 Physico-chemical 1.762,77 745,45 2.288,97 2.552,07 Metals 1.010,00 430,00 1.310,00 1.460,00 Sub-total 16.968,35 7.120,37 21.993,46 24.503,95 Base Line Year 2001 2002 2003 Systems 30 30 30 Determinations Coliforms 108,90 108,90 108,90 Turbidity/pH 7,50 7,50 7,50 Physico-chemical 263,10 263,10 263,10 Metals 300,00 300,00 300,00 Sub-total 679,50 679,50 679,50 Total 16.968,35 7.799,87 22.672,96 25.183,45

310 Guidelines for the Surveillance and Control of Drinking Water Quality

Identification - Location Systems built

Establishment of methods of analysis

Implementation and complementation of laboratories

Establishment of sampling systems

Chlorine residual Sampling program in 203 + 90 determination systems, with data collection on forms provided

Physico-Chemical analysis Microbiological analysis

Consolidation of information -Findings -Final report

Figure 1. Program for the Surveillance of Drinking Water Quality, SANBASUR Project

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Table 4. Sampling Plan for the Surveillance of the Water Quality, and Water Supply Administrations and Systems SANBASUR PROJECT - (2001)

Water Supply Systems Province Administrations Surface Ground Total Acomayo 6 0 6 6 Anta - - - - Calca 11 0 12 12 Canas - - - - Canchis 1 0 1 1 Cuzco - - - - Chumbivilcas 45 0 56 56 Espinar - - - - La Convención 13 2 16 18 Paruro 37 0 45 45 Paucartambo - - - - Quispicanchi 48 0 65 65 Urubamba - - - - TOTAL 161 2 201 203

312 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 5. Summary of the Water Supply Systems SANBASUR Project Ground and Surface Water

Size of Population Province Total <200 201 - 800 801 - 2000 Acomayo 6 2 4 0 Anta ------Calca 12 7 5 0 Canas ------Canchis 1 0 1 0 Cuzco ------Chumbivilcas 56 29 23 4 Espinar ------La Convención 16 11 5 0 Groundwater Groundwater Paruro 45 23 20 2 Paucartambo ------Quispicanchi 65 35 27 3 Urubamba ------Acomayo 0 0 0 0 Anta ------Calca 0 0 0 0 Canas ------Canchis 0 0 0 0

Cuzco ------Chumbivilcas 0 0 0 0

Surface La Convención 2 0 2 0 Paruro 0 0 0 0 Paucartambo ------Quispicanchi 0 0 0 0 Urubamba ------Subtotal 203 107 87 9 Espinar ------Total 203 107 87 9

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Table 6. Number of Samples for Physico-Chemical Analysis Groundwater 2001

Treatment plant, sources of groundwater Distribution network Systems and service reservoirs Province (N.°) Size Turbidity Physico- Turbidity Coliforms Metals Coliforms and pH chemical and pH Acomayo 2 <200 12 24 2 1.0 12 24 4 201 – 800 24 48 4 2.0 48 96 0 801 – 2,000 0 0 0 0 0 0 Calca 7 <200 42 84 7 3.5 42 84 5 201 – 800 30 60 5 2.5 60 120 0 801 – 2,000 0 0 0 0.0 0 0 Canchis 0 <200 0 0 0 0.0 0 0 1 201 – 800 6 12 1 0.5 12 24 0 801 – 2,000 0 0 0 0.0 0 0 Chumbivilcas 29 <200 174 348 29 14.5 174 348 23 201 – 800 138 276 23 11.5 276 552 4 801 – 2,000 24 48 4 2.0 72 144 La Convención 11 <200 66 132 11 5.5 66 132 5 201 – 800 30 60 5 2.5 60 120 0 801 – 2,000 0 0 0 0.0 0 0 Paruro 23 <200 138 276 23 11.5 138 276 20 201 – 800 120 240 20 10.0 240 480 2 801 – 2,000 12 24 2 1.0 36 72 Quispicanchi 35 <200 210 420 35 17.5 210 420 27 201 – 800 162 324 27 13.5 324 648 3 801 – 2,000 18 36 3 1.5 54 108

Subtotal 201 1,206 2,412 201 100.5 1,824 3,648

Table 7. Number of Samples for Physico-Chemical Analysis Surface Water - 2001

Treatment plant, sources of surface water and Distribution network Systems service reservoirs Province (N.°) Size Turbidity Physico- Turbidity Coliforms Metals Coliforms and pH Chemical and pH 0 <200 0 0 0 0.0 0 0 La Convención 2 201 – 800 12 24 4 2.0 24 48 0 801 – 2000 0 0 0 0.0 0 0

Subtotal 2 12 24 4 2.0 24 48

Total 203 1,218 2,436 205 102.5 1,848 3,696

314 Guidelines for the Surveillance and Control of Drinking Water Quality

Table 8. Number of Samples for Chlorine Residual Analysis Groundwater - 2001

Treatment plant, sources of Systems Distribution Province groundwater and service (N.°) Size network reservoirs Acomayo 2 <200 24 24 4 201 – 800 48 96 0 801 – 2,000 0 0 Calca 7 <200 84 84 5 201 – 800 60 120 0 801 – 2,000 0 0 Canchis 0 <200 0 0 1 201 – 800 12 24 0 801 – 2,000 0 0 Chumbivilcas 29 <200 348 348 23 201 – 800 276 552 4 801 – 2,000 48 144 La Convención 11 <200 132 132 5 201 – 800 60 120 0 801 – 2,000 0 0 Paruro 23 <200 276 276 20 201 – 800 240 480 2 801 – 2,000 24 72 Quispicanchi 35 <200 420 420 27 201 – 800 324 648 3 801 – 2,000 36 108

Subtotal 201 2,412 3,648

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Table 9. Number of Samples for Chlorine Residual Analysis Surface Water – 2001

Treatment plant, sources of Distribution Province Systems (N.°) surface water and service Size network reservoirs La Convención 0 <200 0 0 2 201 – 800 24 48 0 801 – 2,000 0 0 Sub-total 2 24 48 Total 203 2,436 3,696

Table 10. Projections

Year 2001/base 2001 2002 2003 Administrations 161 187 217 247 Systems 203 233 263 293 Determinations Coliforms 3,066 3,520 3,973 4,426 Turbidity/pH 6,132 7,039 7,945 8,851 Chlorine residual 6,132 7,039 7,945 8,851 Physico-chemical 201 231 261 291 Metals 101 116 131 146

ANNEX 10

SANITARY INSPECTION REPORT FORM

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SANITARY INSPECTION OF THE SYSTEM

In the Sector/Annex (Community) of ...... …..of the locality of ...... , district of ...... province of ...... and department of ...... , on this day (date)...... of (month)...... of 20...... the sanitary inspection of the system was carried out with the participation, on behalf of the Water Board, of the following:...... and on behalf of the Ministry of Health, Mr/Ms......

As a result of the inspection of each of the parts of the system and of the water samples, a deterioration was detected in the quality of the water consumed by the population, which is placing their health at serious risk; for this reason, improvements will have to be made in the water supply system, to improve the conditions of the supply of drinking water. The main defects identified are noted below:

Intakes and Water Reunion Boxes There is no protecting fence to prevent the access of people or animals to the installation or its vicinity There is no surface water diversion ditch, or it is not in good condition There is no sanitary lid, or it has no lock The structure is not in good condition (cracked or leaking) The inside of the structure is dirty There are puddles of water or fecal matter in the vicinity of the intake structure Deep Well There is no well housing or it is not protected against the entry of people or animals The pump is not mounted on a concrete slab, or the slab is cracked The mouth of the well is at the same level as the concrete slab There are puddles of water or fecal matter in the vicinity of the well Filtration Gallery and Water Reunion Boxes There is no protecting fence and people or animals have access to the installation or its vicinity There is no sanitary lid, or it has no lock The structure is not in good condition (cracked or leaking) The inside of the gallery is dirty There are puddles of water or fecal matter in the vicinity of the gallery Intake of Surface Water without Treatment There is no protecting fence and people or animals have access to the intake structure or its vicinity Conditions are such that surface water can enter the treatment ponds The intake is not in good condition (cracked or leaking) The inside of the intake structure is dirty There are puddles of water or fecal matter in the vicinity of the intake structure Conduction Line/Pumpline The line has leaks or ruptures Stretches of the line are above ground The above-ground crossings are not well protected or are not in good condition Air-vents and Pressure-relief Boxes in the Conduction Line There is no sanitary lid, or it has no lock The structure is not in good condition (cracked or leaking) There are puddles of water or fecal matter in the vicinity of the structures Reservoir There is no protective fence and people or animals have free access to the reservoir

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There is no sanitary lid, or it has no lock The reservoir is not in good condition (cracked or leaking) The inside of the reservoir is dirty There are puddles of water or fecal matter in the vicinity of the structure Feeder Main The pipe is leaking or broken Stretches of the pipe are exposed Pressure-Relief Boxes There is no sanitary lid, or it has no lock The structure is not in good condition (cracked or leaking) There are puddles of water or fecal matter in the vicinity of the structure Distribution Network The pipe is leaking or broken Stretches of the pipe are above the ground The valves do not have boxes or lids and water has collected in puddles Public Standpipes The structure of the faucet is not in good condition (cracked or leaking) The faucets are very dirty The fittings and/or tap of the faucet are not complete or are not in a good condition There are puddles of water or fecal matter in the vicinity of the public standpipe Chlorination There is no chlorination equipment The equipment is not in good condition The equipment is not used There is no stock of chlorine Use of Water A great deal of water is used watering the streets A great deal of water is used watering the vegetable gardens Home Connections The faucets in the homes are in bad condition Water has collected in the connection boxes

...... Signature Signature Signature Inspector Administrator Operator

ANNEX 11 QUALITY ASSURANCE OF DATA

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1. Introduction

The different activities conducted by the surveillance and control staff should be assessed to ensure the quality of the data collected throughout the evaluation process. Form E-1 is applied for this purpose. It was designed to assess staff performance in five stages:

Number of evaluations conducted. Consistency of results. Number of direct supervisions. Number of field verifications. Quality of field work.

2. Number of Evaluations Conducted (1)

On Form E-1, opposite the name of the person responsible for the surveillance or control, indicate how many of each type of form have been completed by him/her during the month.

3. Consistency of Results (2)

The Supervisor should carefully check answers to questions in each of the different types of forms that have been completed and submitted by the field surveillance and control staff.

This revision is to determine whether the person responsible for field work has answered all of the questions in the forms relating to the installation being evaluated, and whether, in the supervisor's opinion, the answers are reliable and coherent with reality.

Acceptance or rejection of a form is decided taking into account, in the first place, the number of obligatory answers and, secondly, the reliability of the answers.

If the obligatory questions in each of the forms have not been completely answered, the form is returned so that the person responsible can complete the missing data.

With regard to reliability of the results, the number of apparently mistaken answers in the form will be counted, and the form will then be accepted or rejected according to the following criteria:

324 Guidelines for the Surveillance and Control of Drinking Water Quality

Number of questions with doubtful Number of questions per form reviewed or mistaken answers Accept Reject 6 – 8 0 1 9 – 12 1 2 13 – 20 2 3 21 – 30 3 4 31 – 42 4 5 43 – 65 5 6

In line 2 of Form E-1, it should be noted whether the forms were accepted (A) or rejected (R).

4. Number of Direct Supervisions (3)

This section refers to the number of times the supervisor helped or supervised the personnel responsible for completing the forms. This activity is known as direct supervision or field training. The number of forms which the supervisor helped to complete or supervised is recorded in the appropriate space, for each type of form.

5. Number of Verifications Conducted in the Field (4)

The supervisor will record – for each type of form – the number of forms selected and verified in the field.

6. Quality of Field Work (5)

This value is determined for forms selected and verified in the field by the supervisor (step 4).

The supervisor records in line 5 the percentage of errors made by the person responsible for gathering data in the field, referring only to the number of questions answered.

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The information is rejected if the percentage of mistaken answers is higher than ten percent (10%).

Example:

The supervisor evaluated three forms of the M-2 type, in which 60 questions were answered in each form, and four, six and five errors were found, respectively. The error is determined as follows:

4 + 6 + 5 x 100 = 8.3% 3 x 60

Number of Forms Questions per Form

326 Guidelines for the Surveillance and Control of Drinking Water Quality

FORM E-1

QUALITY ASSURANCE OF DATA

Date of report ______Supervisor ______

Indicate number of evaluations per type of form conducted by each person

Name of person Evaluation FORM evaluated (1) M-1 M-2 M-3 M-4 M-5 M-6 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1. Number of forms completed within the month, per type 2. Consistency of results (A = Accepted; R = Rejected ) 3. Direct supervision (number of forms supervised) 4. Verification in the field (number of forms verified) 5. Quality of work (percentage)

Form M-1 Community Registration. Form M-2 Assessment of Management and Coverage. Form M-3 Assessment of Sanitary Condition of the Water Supply Infrastructure. Form M-4 Water Sample Collection and Assessment of Service Quality. Form M-5 Verification of Habits of Hygiene and Presence of Diseases in the Community. Form M-6 Verification of Habits of Hygiene in the School Population.