RECOMMENDATIONS

of the participants at the

INTERNATIONAL WORKSHOP
on
ARSENIC MITIGATION

held at Dhaka 14th - 16th January 2002 at the request of the

Government of Bangladesh

The recommendations come in three groups:

HEALTH
ALTERNATIVE WATER SUPPLY
HYDROGEOLOGY

You are invited to comment upon these recommendations and your comments will be posted on the website and forwarded to WHO and the Government of Bangladesh. Please make comments on specific recommendations if possible so that they may be most effective. Send to me at wilson@huhepl.harvard.edu.

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ALTERNATIVE WATER SUPPLY COMPONENT

GENERAL OBSERVATIONS

The alternative water supply groups recognized that:

1. Alternative Water Supply Options

Despite many constraints the following alternative water supply options are recommended:

Emergency Option:

In acute arsenic problem areas an alternative safe water point appropriate in the area is to be provided in each village on an urgent basis following ongoing national screening program.

Short-term Options (Alphabatically, not in order of priority) :

Long-term Options: 2. Site Specific Selection of Options

The possible sites for different alternative technologies are given below:

Deep Tube Wells

Manually operated deep tubewells are source of safe and reliable water supply in many parts of the coastal area. In other areas, safe deep aquifers may be available to produce water of acceptable quality for water supply.

Requirements

Dug/Ring Wells

Dug wells may be constructed where feasible for arsenic safe water supplies. The areas with aquifers at shallower depth and the hilly areas are suitable for construction of dug wells. The areas with thick consolidated clay layers are not suitable for dug well construction. There should be a sanitary protection and provision for disinfection of dug well water.

Caution

Dug/ring wells are to be tested in an acute arsenic problem areas for arsenic content under following conditions of :

Rainwater Harvesting

Rainwater harvesting has good potential for water supply in arsenic and salinity affected areas in Bangladesh. It is suitable in the coastal islands, south-western part of coastal area and hilly regions of Bangladesh.

Requirements

Surface Water Treatment

Treatment of surface water can be a option in any part of Bangladesh having perennial surface water of adequate quantity and of good quality. The flowing rivers, reservoirs, oxbow lakes protected ponds are preferred sources. The technologies include:

Requirements: Treatment of Arsenic Contaminated water

Some units developed for treatment of arsenic at household and community levels and installed for experimental use in different parts of Bangladesh have shown very good potentials for use in water supply in all arsenic affected areas.

Centralized arsenic removal plant for urban water supply is possible.

In period of scarcity, arsenic treated water may supplement other sources.

Caution

Piped water Supply

Piped water supply is the long-term objective. In an urban center with piped water supply, the people dependent on shallow tubewells can shortly be brought under piped water supply through expansion of existing areas of service coverage. Piped water supply should also be introduced in the urban centers fully dependent on contaminated shallow tubewells. Arsenic removal would be required for the few urban centers having arsenic contaminated production wells.

Piped water supplies are also possible for clustered households in villages, growth centers and the rural areas having good rural road network.

Arsenic safe water for piped water supplies may be available from any sources such as deep tubewell, treated surface or arsenic contaminated water or water from community dug wells.

3. Monitoring and Surveillance:

Performance and quality of water of the existing safe tubewells and the proposed short-term options need regular monitoring and surveillance.

4. Institutional Arrangement for Implementation of Alternative Water Supply

4.1 Vision Statement:

Safe and adequate amount of water will be provided for drinking and cooking in all households through effective, efficient and sustainable institutions. Services will be provided and managed locally, which will be transparent and accountable to the people. National interests and public goods issues will be addressed by the Central Government.

(Safe: arsenic-safe, free from other chemical and microbiological pollutants)

4.2. Role of the Central Government

  1. A national legislation for water quality and supply for regulation, monitoring and implementation should be developed. National Water Council must play an important role in this process.
  2. The regulatory capacity of DPHE to provide technical guidance and monitoring for supply of safe water should be strengthened.
4.3. Role of Local Government a. The governmental policy of decentralized provision of services related to safe water options through the Union Parishads (UP) should be operationalized immediately. This will lead to a much closer involvement of local government in the implementation of safe water options.

b. UPs should also be involved in mobilizing resources, monitoring and information management; more specifically registration of tube wells can be undertaken by the UPs.

    1. Role of Communities and NGOs
a. Local communities must be facilitated and empowered to undertake planning, implementation and management of safe water options. This should be based on informed choices. NGOs must play a vital role in this process.

b. There should be a strong focus on capacity development at the local and/or community level for technical implementation and monitoring.
 
 

  1. Formation of user groups for local implementation and monitoring should be encouraged throughout the country with support from NGO’s and the local government.
4.5. Role of the Private Sector a. The private sector can play a key role in implementation of safe water options and interacting with the end users. This role should be included in the mainstream national policy for provision of safe water options and development of innovative, enterprising solutions should be encouraged.
 
  1. Involvement of private sector in financing of well monitoring and safe water options should be encouraged through tax relief and other incentives.
4.6. Capacity Development a. Institutional capacity development for the regulatory functions and monitoring should be undertaken by the Central Government (Ministry of LGRD and Cooperatives).

b. Capacity development at the local and community level should include technical capacity for installation, operation & maintenance, and monitoring should be a key element of the national policy. This should also include the capacity for information management and reporting.

4.7. Information Management and Applied Research
  1. Knowledge and information should be managed centrally to ensure transparency of the implementation process. Ready accessibility of information to all stakeholders is essential. Governmental institutions, such as NAMIC, should undertake this sustained role of functioning as an information warehouse at the national level.
  2. Centers of excellence on relevant research on safe water options should be developed. These centers should focus on existing information and knowledge leading to identifying and conducting research on key areas.
5. Task Force

A Task Force led by DPHE may be constituted to undertake prioritizations of safe water options and develop strategies for their implementation.

The Task Force should focus on: (i) a clear time frame for implementation; (ii) the formulation of a protocol that includes technological and socio-economic criteria; and (iii) a strategy for information management and dissemination.

The Task Force will formulate the roles and responsibilities of the ministries, departments and directorates, local government institutions, research institutions, private organizations, NGOs and CBOs.

The information emerging from the Task Force should be adequate for making informed choices by communities.

6. Researches and Development

There are many areas of research and development in diverse fields of alternative water supplies in Bangladesh. Some of them are listed below:

HEALTH THEME GROUP
Preamble:

The overriding priority for the health of the people of Bangladesh is to ensure access to wholesome and pure, arsenic free, and bacteriologically safe, water.       Time is too short, we need to act now!!!

Implication of health effects and impacts were presented and discussed by more than thirty experts from home and abroad. Three key presentations in the fields of diagnosis, treatment and research were debated and recommendations made thereon.
•Case Diagnosis Guideline
- Prof. M A Khalique Barbhuiya
•Management Protocol
- Prof. M Mazibul Haque
•Research Priorities
- Dr Harunur Rashid

Case diagnosis guidelines: - Summary

• Three Flow Diagrams were suggested as diagnostic guidelines by Professor MA Khalique Barbhuiya
• Following extensive discussion amendments were made and one comprehensive flow chart was agreed that can be used at the field level.   The flow diagram for diagnosis of arsenicosis (PART-I) is not yet available in digital form to this webmaster.
Recommendations(diagnosis)
• Issues related to Arsenicosis both clinical and public health should be incorporated in the Undergraduate Medical Curriculum as well as Training of Paramedics
• Set-up and maintain an effective and proper referral chain for clinical case management of Arsenicosis cases
• Preventive and Social Medicine should be incorporated
• Health Workers need to be trained as soon as possible on case detection and management
• Detection and reporting of cases should be implemented - the hierarchical classification was endorsed
• Establish a Multidisciplinary National Task Force for identification, monitoring and recommendations on (mitigation of) health impacts

Case Management - Summary

• The Management Protocol provided a table containing - Manifestation, Stages and Recommended Management process.
• As the asymptomatic patients won't seek any clinical intervention - it should be deleted from the management protocol.
• Scientific proof is necessary before incorporating the anti-oxidants like Beta Carotene and vitamin C and E in the recommended management protocol.
• The structure of the Management Protocol should not contain any staging
• Add follow-up and counseling to the management protocol
• The role of Keratolytic Agents is merely palliative - if given, then 5-20% salicylate should be used.
• The management protocol should include a footnote as follows:

Beta carotene, Vitamin C and E is thought to be helpful for Arsenicosis Management but are yet to have a proven role.
Appropriate nutritional supplement should be given to those who are malnourished

Research- Summary

• Up to this date 73 research studies have been conducted or are ongoing on health impact of Arsenic Exposure - 8 on management or clinical trials
• There is a need for coordinated research - both interdisciplinary and intersectoral was highly emphasized
• A multi-disciplinary, autonomous, International Centre for Arsenic Mitigation should be established in Bangladesh
• High quality laboratories for epidemiological and diagnostic investigation should be established in Bangladesh
• A multi-disciplinary, autonomous, International Centre for Arsenic Mitigation shouldbe established in Bangladesh
• There is a need to coordinate research - including interdisciplinary and intersectoral research.
• Keep room for Investigator Initiated Research

Seven Priority Areas
for research in health are:-

• Prevalence study - exposure, cases including the dose-response relationship
• Clinical trials - showing the effect of antioxidants and other drugs
• Effects on young, especially neonates and infants
• Effects on Reproductive Health
• Health effects/impacts of alternative water options
• Long-term cohort - interdisciplinary
• Bio-availability and food chain
Other Priority areas
for research in health are:-
• Low cost management
• Natural History
• Pre-clinical - GI tract (absorption role)
• Non-cutaneous manifestation and involvement of other organs
• Long-term risk associated with arsenic-caused carcinoma
• Pharmocodynamics and kinetics of arsenic in the body
• Factors related to Arsenicosis

Recommendation of the Hydrogeology Group

Screening of Tubewells

  1. Government has given due priority of screening of all tube wells. It is recommended that the process be accelerated and screening of all the tube wells both hand pumps and irrigation wells (approx. 10 million) be completed by field kits on Priority Basis in highly contaminated areas in accordance with the guide lines of the Government’s Policy for Safe Water Supply and Sanitation, 1998 . ( Short term)
  2. Reliable testing facilities should be available to people at a reasonable cost. (short term).
  3. Quality control of field surveys is essential for which Reference Laboratories to validate field test results be established on a priority basis (short term).
Monitoring of screened tubewells
  1. System be developed to monitor the presently found safe wells, if possible once a year ( mid term goal).
Aquifer Mapping
  1. Immediate mapping be based on existing data of tubewells on Arsenic concentration and depth of wells if location is available. This should be used as local level guide for new tubewells (short term ).
  2. Priority Project should be undertaken to find criteria for mapping the Upper, Middle and Lower aquifers ( Holocene and Plio-Pleistocene sediments) on Upazila as units. Union level exercise may be tried at a later date ( mid term).
  3. Because arsenic is related to geology, a priority project should be undertaken for mapping of facies, geometry and chemistry, and classification of the Holocene sediments and correlate them to the aquifer systems.
Groundwater Management
  1. In those areas where groundwater is known to be safe, it should continue to play a role in providing safe water supplies. But this must be supported by a monitoring program (short term).
  2. In arsenic affected areas, no new irrigation wells should be installed in the arsenic safe aquifer to protect the presently safe water supplies. This aquifer is frequently found at greater depth. (Short term).

  3.  

     
     
     

  4. The abstraction rate of the safe aquifers needs to be determined to assess the potential for sustainable future water supplies from this resource (short term).
  5. Ensure that the entire population has access to arsenic safe water (mid term).
  6. Determine uses that require arsenic safe water such as cooking, drinking and agricultural, etc (short term).
  7. Monitor the quality and quantity of groundwater for those purposes requiring safe water particularly for arsenic (mid term).
  8. Develop enforceable standards for water well construction to prevent cross-contamination of aquifers (short term).
Research

       #  Investigate the source, release mechanism and mobilization of arsenic in the ground water on a priority basis ( short term).
       #Detailed analyses and transport properties of the aquifer sediments should be undertaken (mid term).
      #Research on soil build-up of arsenic through arsenic laden irrigation water and bio-availability of arsenic and its subsequent entry into crop, agriculture and food chain (mid term).
        #Evaluate methods of in-situ arsenic removal from groundwater as an alternative method for supplying arsenic safe water ( mid term).

  1. Evaluate the effects on hydrologic and geochemical systems to actual and future development of the groundwater resource (short term).
  2. Identify isotopic signature of arsenic contaminated water from arsenic safe deeper aquifers and to study the interactions between shallow and deeper aquifers (mid term).
  3. Investigate the seasonal changes in arsenic concentration and other information required to develop a reliable and cost effective monitoring program (short term).
  4. Develop simple tools to assist local drillers in site and depth selection (mid term).
Administrative and Legal Issues
  1. Groundwater is a valuable natural resource. A suitable "Groundwater Act" should be enacted to control all activities regarding sustainable groundwater exploration, development and management (short term).
  2. A national standard should be established for arsenic content of irrigation by groundwater (short term).
  3. There is no single organization in the country that deals with all aspects of groundwater although all our neighboring countries have organizations such as "Groundwater Commission", "Groundwater Board" or "Groundwater Agency". The Government should create or identify an organization bringing all the personnel working on groundwater under one umbrella organization.
  4. Government should coordinate all stakeholder activities in the sector based upon their approved strategy.
  5. Local Government Institutions should be given sufficient resources in recognition of its key role in ensuring provision of arsenic safe water to the people.
  6. An international center for groundwater related research and training needs to be established in the country.