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More than a Drop in the Bucket: Decentralized Membrane-Based Drinking Water Refill Stations in Southeast Asia Laura C. Sima and Menachem Elimelech* Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut 06520-8286, United States neighborhoods in developing countries.3−5 In urban slums, centralized piped systems are hard to maintain, billing and payment systems are difficult to organize, and there is little political pressure for services. Access to safe water is not only a problem for the poor in developing countries. In most urban regions of developing nations, tap water is contaminated as it passes through leaking pipes during distribution.6 Studies in Argentina,7 Mexico,8 Trinidad,9 Tajikistan,10 Cambodia,11 and South Africa 12 found that water collected from household taps contained indicator pathogens, whereas water at the treatment plan did not, likely as a result of contamination within the distribution system. In Jakarta, Indonesia, one study found tap water to be more Decentralized membrane-based water treatment and refill contaminated than any other water sources, including untreated stations represent a viable and growing business model in groundwater.13 As a result of these risks, consumption of Southeast Asia, which rely upon the purchase of water from bottled water, especially among higher income earners, is refill stations by consumers. This feature article discusses these growing worldwide in developing countries.14−17 This trend is water treatment and refill stations, including the appropriateof special concern given the significant associated consumption ness of the technology, the suitability of the business models of nonrenewable petroleum-derived resources, used both to employed, and the long-term environmental and operational sustainability of these systems. We also provide an outlook for produce disposable plastic bottles and to distribute the bottles the sector, highlighting key technical challenges that need to be by freight.18 The disposal of bottles also poses a significant addressed in order to improve the capacity of these systems, challenge in developing countries where solid waste managesuch that they can become an effective and financially viable ment is unorganized.19,20 Consequently, only a small portion of solution. plastic waste is recycled,21 and plastic bottles may be thrown directly into water bodies, contributing to the pollution of these early eight hundred million people lack access to 1 ecosystems, or be incinerated, resulting in the release of toxic improved water sources. Many more consume conairborne materials.15 taminated, unsafe water from “improved” sources.2 ConvenDecentralized water treatment and refill stations operate in tional approaches, including extensions of piped water services parallel to existing government water treatment and distribuand construction of deep tube-wells, have often failed to tion schemes in developing countries. Such stations treat water improve access to the most vulnerable populations, such as 3 onsite and sell it to consumers by volume, typically by refilling those residing in urban slums and rural areas. Advances in 10 gallon water containers. Most refill stations employ modular membrane-based treatment processes, coupled with membrane-based technologies. Membrane-based refill stations operating models that rely on for-profit decentralized drinking use ultrafiltration or a reverse osmosis membrane separation water treatment and delivery, offer a new approach that could process, usually coupled with activated carbon adsorption and potentially increase access to improved drinking water in UV or a chlorination disinfection.22,23 These stations are a developing countries. With many potential customers, a rapidly rapidly growing business in developing countries. Figure 1 evolving, highly customizable set of technologies, and a illustrates the dramatic growth in the number of stations over sustainable, income-generating model, decentralized drinking the previous decade. Indonesian membership to a voluntary water refill stations may be a viable alternative to existing water refill association grew by more than 800% between 1997 approaches in the short term. and 2008,22 and a private-public partnership constructed over The Millennium Development Goals aim to reduce by half 300 stations in India between 2005 and 2012.24 Decentralized the world’s population that lives without access to improved drinking water treatment refill stations continue to be put into water by 2015. Although we are on track to meet these goals, operation around the world, including in the Philippines,25 much of the progress has been made in countries that have seen Kenya,26 and Mexico.17 Although water refill stations are only stable and high economic growth in the past decade, like India present in some parts of the world, rapid growth in these areas and China.1 Significant progress in these regions overshadows a motivates a critical evaluation of the sector. lack of progress in many of the neediest areas. The privatization of municipal systems in the 1990s has improved operational efficiency, but done little to increase access to water in poor Published: May 31, 2013
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Figure 1. Growth in membership for the association of water refill station operators in Indonesia (APDAMINDO, 2005−2008) and WaterHealth in India (1997 to 2008) with images of the system for WaterHealth and APDAMINDO. Graphs were prepared from data presented by the president of the APDAMINDO association 22 and WaterHealth representatives.24 The image of a water refill station was taken by the authors at a water station on Lake Toba in Indonesia. The bottom image was provided by Safe Water Network in India for use in this article.
Safe tap water for every urban and peri-urban household remains the aspiration of citizens and governments in many of the poorest areas of cities around the world and the Millennium Development Goals have motivated investment in this area during the past decade.1,27 Globally, access to “improved” drinking water increased dramatically,1 but access to “safe” water has been more elusive as water delivered from the pipe or well is often contaminated.28 Conventional engineering approaches for piped water infrastructure fail frequently in the rapidly developing cities of low-income countries due to rapid rate of urbanization, 29,30 frequent system breaks attributed to increasing frequency of natural disasters 31 and vulnerability from climate change,32,33 and inefficacy of governmental intervention for the neediest populations due to a lack of land tenure and property rights in many of the informal settlements where the poorest reside.34 Approaches will have to be redesigned and investment must be increased before universal safe tap water access becomes a reality. In the short term, a number of approaches to improve safe water supply in developing countries have been promoted, including household-level treatment. However, although these approaches have increased access to water for some populations, none has been a silver bullet for intermediate increases in access to safe water as the problem is enormously complex. This paper seeks to introduce a new and growing, short-term alternative to high-quality piped municipal systems and household water treatment for drinking water, namely decentralized membrane-based drinking water treatment and
refill stations. With a few exceptions, there has been a paucity of peer-reviewed research in this topic area, leaving the field ripe for exploration. The key factors that distinguish membrane-based refill stations from conventional approaches are discussed in this article. These factors include the appropriateness of the technology, the adaptability and acceptability of business models, the sustainability of this approach, and the potential for future advancement in the area. Specifically, we address the following questions: Are membrane-based systems an appropriate technology in low-income areas? Can decentralized membrane-based water refill stations serve low-income populations while remaining financially viable? Are decentralized membrane-based drinking water refill stations sustainable? Addressing these questions and understanding the limitations of this approach will provide critical information needed to inform the decisions of policy makers, international funding agencies, engineers, and scientists on the suitability of membrane-based refill stations to address access to safe water in low-income areas globally.
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ARE MEMBRANE-BASED SYSTEMS AN APPROPRIATE TECHNOLOGY IN LOW-INCOME AREAS? Original proponents of the term “appropriate technology” emphasized that solutions in developing countries should be small-scale, energy efficient, environmentally sound, and use locally available resources. They should also have a low capital 7581
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Figure 2. Maps depicting water refill station use in various Indonesian provinces with comparison of urban and rural use. Data from the National Socioeconomic Survey (SUSENAS, 2010) was purchased from the Central Bureau of Statistics (Badan Pusat Statistik, Jakarta, Indonesia) and displayed using ArcGIS 10.1 software. Indonesian provincial basemap was acquired from the Indonesian Ministry of Forests (MoF).
criteria will be discussed in further detail in sections to follow. In this section, we will focus on whether membrane-based decentralized systems are a viable technical solution and whether they are appropriate for operation in specific areas of developing countries. Several water treatment products have been designed using the original criteria of “appropriate technology” for developing countries. These products are generally built using local, relatively inexpensive materials, and operated in the household. Examples include filters (e.g., LifeStraw family, clay pot, and biosand filters), disinfection systems (e.g., the CDC Safe Water system of chlorination combined with safe storage, and sunlight inactivation of pathogens, SODIS), and combined coagulantchlorine disinfectant products (PUR).43,44 Unfortunately, none of these technologies have been a silver bullet in addressing the critical challenge of improved access to safe water in developing countries. To understand the technical viability of water treatment technologies, we will first consider their capacity to provide safe water. Unlike multibarrier municipal water treatment, most household-level treatment technologies are single-barrier. In regard to pathogens removal and inactivation, each of these options has limitations. Specifically, ceramic and slow sand filters remove bacteria, but do not provide high removal rates of viruses.43 Chemical disinfection could inactivate viruses, but becomes less effective in water with high ammonia and nitrogen
investment per person served and be capable of being controlled and maintained by the local community.35−37 Decentralized membrane-based water treatment systems, though they are small-scale and co-owned by the community in some instances, fail to meet nearly all of these criteria. Cell phones, however, as an example of an expensive technology that requires electrical supply, also do not meet any of these criteria. In the past decade, the cell phone has become one of the most prolific technologies in developing countries and has shaped the landscape of rural Africa by a leapfrog advancement, which did not require the installation of land lines for communication.38,39 As globalization facilitates the supply of goods, some have called for a reevaluation of the criteria for what is considered appropriate technology for water and sanitation in developing countries.40 Given that the design of technology appropriate for developing countries is an increasingly profitable business for manufacturers and distributors,41 such a reevaluation is not only justified, but also timely. Developing credible and appropriate technology criteria requires long-term dedicated effort and is outside the scope of this article. Rather, we adopt well-established, flexible sustainability criteria that suggest appropriate technology be (1) a suitable technical solution, (2) economically viable to the population, (3) capable of being maintained and sustaining operation, and (4) designed for the environment in which it is operated.42 The second and third 7582
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content, as these chemicals react to quench hypochlorite.45 The addition of a larger dose of chlorine to overcome this limitation increases the formation of toxic disinfection byproducts and alters the taste of product water, often making it unpalatable to consumers.46 UV disinfection (SODIS) is not effective in turbid water, as microbial pathogens are shielded by suspended particles, and UV light is not intense enough to inactivate pathogens under nonideal sunlight intensity conditions.47 PUR, which combines coagulation, disinfection, and filtration, should remove viruses and other pathogens with high efficiency if operated effectively. However, the process is relatively difficult, and compliance have been very low.44 Furthermore, none of these systems directly address chemical contamination. Unlike other alternatives to municipal treatment, membrane-based refill stations usually involve several treatment steps: (1) microfiltration/ultrafiltration/reverse osmosis, (2) granularactivated carbon for organic contaminant removal, and (3) UV disinfection. If operated effectively, and assuming no maintenance issues, treatment should remove viruses and some chemical contaminants under a wider variety of source water conditions. Unlike single-barrier approaches to water treatment, multibarrier membrane-based processes have built-in redundancy that decreases the chance of failure. The operator of any water treatment technology will require some technical training to use and maintain the system.2,44 Training is especially difficult for household-level technology as each household head must be able to operate a complex system.44 Indeed, user adoption and compliance have been the limiting factor for rapid growth in household water treatment technology thus far.44 This is not surprising since any consumer technology that requires more complicated steps and makes daily tasks more difficult is likely to be unappealing to consumers.48 As is the case with any other treatment technology, it may be difficult to get people to adopt athome filtration or membrane-based treatments if use requires extensive behavior change. However, in comparison to other treatment methods, membrane-based systems require minimal specialist input for operation, although trained technicians are required for repairs. For example, some membrane systems utilize built-in sensors that automatically stop water flow if a sensor detects product water of high turbidity,49 while some centrally operated decentralized systems use remote sensing to do the same,50 a method which improves reliability and facilitates replication at scale compared to systems that use other technologies. Additionally, community-scale systems require that only specialist operators be technically trained, lowering the cost of training overall by reducing the number of people that need to be trained.22,50 On the consumer’s end, the purchase of clean drinking water is an already-accepted behavior in cities,51−53 which is likely to make the adoption of household water treatment interventions a challenge. A series of integrated behavior-change programs will, therefore, likely be necessary to motivate potential users to adopt such interventions.48 The appropriateness of a technology will differ, depending on the environmental context, with criteria for urban or rural areas likely very different. In urban and peri-urban areas, where population density is large and land value is high, the footprint of any technology may be directly related to its appropriateness. Water refill stations have a small footprint and modular design. A typical unit requires 18 m3 of floor space in Indonesia 49 and 20−25 m3 in the Philippines,25 making it possible to install units in existing storefronts, which would not be feasible with
conventional, not membrane-based systems. As shown in Figure 2, water refill stations are most common in urban areas of Indonesia. In rural areas, electricity and transportation are more expensive than in urban areas, while land use may be of lesser concern. Although solar panels are becoming cheaper and more prevalent, the reliance on electricity will likely limit the viability of membrane-based refill stations. Another limitation may be the relatively higher cost of transportation and lower population density in these areas. Finally, population density may not be large enough for refill stations to become financially viable. The small footprint of the systems, however, may be a benefit even in rural areas, given that it can reduce capital costs simply by decreasing the size of the space on which the system is built compared to conventional sedimentation-based treatment systems. Likely due to a combination of these factors, refill stations are less prevalent in rural than urban areas of countries in Southeast Asia.54,55 Whether refill stations are developed in rural or urban areas, the rate of change of population growth and demand may limit profitability for businesses, as it may be difficult to gauge the level of demand of a new system within any given population. The modular design of membrane-based systems offers many advantages that lower system cost, including rapid, affordable installation and the ability to replicate and scale treatment capacity to meet anticipated demand. For example, the Safe Water Network sizes treatment plants depending on anticipated demand, so that additional membrane modules can be added to increase capacity as demand grows.50 In a similar manner, many Indonesian and Filipino distributors offer the option to purchase additional modules to increase capacity as demand grows,25,56 reducing investment risk. The modular nature of the technologies employed enables WaterHealth to install prefabricated units that take less than 21 days to build in rural areas of India.23 Finally, since membrane-based processes can be presented as new, high-tech options to consumers, they have the potential to garner an “aspiration appeal”, which has been deemed increasingly important to point-of-use water technology adoption.44 Behavior change is difficult to motivate due to social, cultural, and household-level factors; technologies for water treatment and delivery that require minimal daily behavior changes to adopt have a better chance of being successful.48 The purchase of water as branded bottled water or as large containers from vendors is already a common practice in many developing countries.51,53 Membrane-based systems could be considered appropriate for low-income consumers, specifically because low-income consumers desire high-tech solutions to have a level of class sensibility. Although consumer preference for a number of household water treatment options has been compared, no similar studies have been carried out that compare preference for membrane-based refill stations to existing options.57,58 Such studies may be the best means by which to gauge appropriateness of different technologies for consumers.
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CAN WATER REFILL STATIONS SERVE LOW-INCOME COMMUNITIES WHILE MAKING A PROFIT? Implementation is often the most difficult aspect of technology dissemination, especially in low-income countries. Although membrane technologies are traditionally more expensive than low-tech, locally constructed alternatives, decreasing membrane 7583
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and has begun building its own.68 Safe Water Network, a U.S.based nonprofit, has primarily funded the two prior organizations, but has recently also started constructing water systems and developing local capacity for these to be operated by entrepreneurs or communities.50 Although the intended business model for these private-public or public−public partnerships will rely on payments from governments, in the developmental stage, most of the initial investments have thus far come from donations.23,50,68 In other areas, a combination of these two models has been used. For example, in Bangladesh, foreign funds have been used to finance WaterHealth International centers,23 and in Ghana, private- and community-owned enterprises have been predominantly funded by third party donors.50 On the other hand, in Kenya, Aquaya Institute is promoting the development of a locally operated, small business sector in water treatment 69 by having previously worked directly with entrepreneurs, organizing conferences around the topic, and presently, disseminating a business-in-a-box model for growing indigenous businesses run by local entrepreneurs. In Mexico, similar systems have developed independently of foreign involvement.17 The examples discussed above show that the management and ownership structure of community-scale water treatment and refill stations is adaptable to local conditions. This capability, lauded within the informal water distribution and electricity sectors, is particularly crucial in meeting the needs of a diverse consumer base.53 Oftentimes, the most difficult aspect of water treatment campaigns in developing countries has been motivating users to adopt consistent water treatment practices and teaching them how to treat water.70 By piggy-backing on bottled water advertising and an increased awareness of health risks associated with bottled water, refill stations in urban areas have been especially successful given that they meet a preexisting, perceived need. In rural areas, however, demand and awareness must often be created, presenting a significant challenge to profitability and sustainability of water stations in villages.50 A number of approaches have been put forth, including the “Dr. Water” branding strategies employed by WaterHealth International.23 In Indonesia, businesses have begun to grow in some rural areas, but constitute a minority of the growth in the country.55
production costs, as well as the coupling of membrane technology with a new, potentially more economically appropriate, delivery scheme, may make this a viable option for many of the world’s poorest people. Membrane-based water refill stations are innovative in two important ways. First, volumetric, incremental pricing makes water affordable to lowincome consumers, yet still profitable for operators. Second, a variety of ownership structures, combined with access to finance, facilitate the startup, operation, and monitoring of businesses. The largest barrier in reaching low-income markets is a lack of disposable income. Products need to be priced and sold in a manner that is accessible to daily wage laborers who have unreliable income streams and little or no capacity to save for large, one-time purchases. A highly effective approach was developed by Procter & Gamble and Unilever, both of which designed one-time-use micropacks for necessities, including shampoos and soaps, which can be purchased individually.59 Although a microsachet of shampoo is not the most economical in terms of cost per volume, the small incremental price is affordable to those living in subsistence economies, such as India60 and Indonesia.61 Measured in tons, the Indian market for high-end shampoo brands, sold in microsachets, is profitable and larger than the U.S. market.62 In a similar vein, refill water purchased from stations may be expensive volumetrically, but the ability to pay for water incrementally could be much more affordable to those who lack savings than an upfront capital investment for an at-home filtration unit or connection fee to the municipality for tap access. Two predominant business models have been used to develop membrane-based water treatment stations that are both profitable and socially acceptable. One is entrepreneurial, growing organically as a large number of small businesses are developed in a variety of areas;22,25,63,64 the other is a publicprivate scheme, with its growth generally dependent on donor organizations and government support or community ownership.65 In both models, water is purchased and paid for incrementally by the consumer, but the ownership, management, and maintenance differ. In some areas, a combination of the two models is used as is illustrated in the following examples. In Southeast Asia, most water refill depots are operated by small-scale entrepreneurs.22,25 Customizable systems are typically purchased from water filtration technology distributors,22 although, in the Philippines, the purchase of equipment is normally also associated with franchise rights that belong to a water refill franchiser.66 The system distributors often provide business training, assistance in acquiring financing, and equipment maintenance, all for a fee. Depending on the location, the source of raw water may either be groundwater (in rural areas), spring water delivered via trucks (in urban areas), or water drawn from existing piped systems.22,64 In India, water refill stations are referred to as “community water systems” or “microutilities” and are operated as private− public partnerships. WaterHealth International, the largest private company in this arena, partners with local governments for investment capital, (though many projects are donorfunded), and is responsible for both acquiring credit, to pay for the remainder of the system, and its operation until the initial capital has been recovered (a period projected to last 8−10 years).67 Loans are repaid from profits made through water sales at these stations. Naandi, a local nonprofit, has been responsible for the operation and maintenance of many systems
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ARE DECENTRALIZED MEMBRANE-BASED WATER REFILL STATIONS A SUSTAINABLE SOLUTION? The sustainability of a water treatment system can be judged in two ways: operational sustainability and environmental sustainability. Operational sustainability in the long term requires that people be incentivized to operate and maintain the system effectively, that replacement parts are accessible, and that there is good quality control of the system. One of the largest hurdles for community water and sanitation systems has been an inability to sustain continued operation and provide maintenance for systems. Informal, for-profit water delivery businesses have been operating in parallel to municipal systems in most cities in developing countries.51 The operators of these water delivery businesses have been recognized for their adaptability and responsiveness in meeting growing demand as they fight to maintain and increase profits.53,71 For example, in Kisumu, Kenya, trucks deliver water to storage tanks in large villas when the municipal water supply is irregular, while handcart operators deliver water to lower-income areas that lack access to municipal supply.52 In a similar vein, drinking 7584
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Figure 3. Maps of water use in Indonesia, comparing percentages of tap water to water refill use. Data from the National Socioeconomic Survey (SUSENAS, 2010) as purchased from the Central Bureau of Statistics (Badan Pusat Statistik, Jakarta, Indonesia) and displayed using ArcGIS software. Indonesian provincial basemap was acquired form the Indonesian Ministry of Forests (MoF).
distribution. However, since water is often transported above ground (by truck or motorcycle) to decentralized treatment centers, and once refilled, from those centers to individual households using a variety of motorized and nonmotorized means of transportation, these systems likely require more energy than conventional municipal water treatment and distribution. As in municipal systems, water treatment and distribution are likely the most energy-intensive steps of the decentralized membrane-based station industry. Since both water treatment and transportation processes differ significantly among treatment and refill stations, the environmental impact of these processes is likely to be different as well. In some areas, untreated water is transported to water stations via trucks from springs, whereas in other areas, water is pumped from a groundwater source22,23 (Figure 2). Some stations use reverse osmosis to treat water,68 whereas others use ultrafiltration followed by UV disinfection.22 A paucity of data prevents any conclusions about energy and nonrenewable resource use for this sector, and further work in this area will be crucial to optimizing systems and reducing the environmental burden associated with water refill stations.
water treatment station operators are incentivized by the profit they make through direct sales to consumers. If services are suboptimal, consumers will elect to purchase water from rival stations, which drives competition among water refill station operators for consumers. This level of competition is crucial to motivate superior service, but is not possible in municipal water systems, some of which exist as monopolies in large cities.5 Access to replacement parts, as well as the technical labor required for their installation, is crucial for continued operation of any system. In developing countries, parts and labor for replacements may be expensive and/or difficult to locate. This is less of a concern for systems in large urban centers, such as Jakarta or Manila, where competition drives down prices for both parts and labor. Indeed, the demand is so high that certification courses in water refill station maintenance are now offered by the Department of Environmental Health at the University of the Philippines Manila.72 This is not the case in rural areas, where operation and maintenance may be a logistical challenge.68 In response, Safe Water Network organizes new station developments in clusters to manage the routine training, maintenance, and purchase of parts from central locations.50 Currently, there is no reliable information for the environmental impact of decentralized membrane-based stations. Since containers are reused, this industry is likely to be much more environmentally sustainable, with regards to net carbon consumption and waste generation, than bottled water
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OUTLOOK Membrane-based decentralized water treatment may have the potential to become a sustainable, appropriate, and financially viable means to increase water access in developing countries. In the future, the number of decentralized membrane-based 7585
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in Jakarta are registered with the organization as of this year.80 In India and Ghana, the organizations that operate water treatment stations hold themselves responsible for water quality and voluntarily test water periodically, but there has been no third-party certification or water quality testing system.23,68 Finally, there is a significant amount of room for technology improvement of decentralized water treatment stations. Although most water treatment technologies designed for developing countries focus on removing pathogens,2 water in large urban areas, similar to air, is heavily polluted by industrial chemicals due to a lack of environmental regulations, and consumers are increasingly concerned about chemical contaminants in their drinking water. Reverse osmosis systems are becoming an increasingly popular technology within the sector, because they are able to reliably remove both biological and chemical contaminants from a wide range of raw water sources. However, reverse osmosis is a relatively energy-intensive process and produces large amounts of concentrated waste streams that are expensive to dispose of, in comparison to other systems. The development of a range of treatment systems, suitable for different source waters, and optimal in their energy use, will decrease the operating cost of water refill stations and increase the environmental sustainability of this growing sector in the long term.
water treatment and refill stations will likely increase in countries where they exist, whereas the industry will likely expand to additional countries. The business model has the highest chance of being profitable in urban and peri-urban areas without municipal connections, where population density is larger, water is more polluted, and the cost for parts and technicians is lower. As urban areas become saturated, businesses will likely expand to rural areas, especially as distribution centers become more numerous and the practice becomes socially recognized. As shown in Figure 3, this is already the case in Indonesia, where a larger portion of the population relies on water from refill stations than tap water in some provinces. In areas of the world where third party investors, such as Safe Water Network, Naandi, or WaterHealth, are involved, external input is promoting growth in rural markets. For continual growth of water refill stations, replicable business strategies and communication among operators in different markets must be developed. To do so necessitates analysis of local business markets, as has been done for Kenya,26 and the development of international groups, similar to the World Health Organization’s Household Water Treatment Network, to disseminate ideas. Additionally business guides, such as the Water Business Kit developed by the Aquaya Institute 69 and the Safe Water Network’s own tool kits,50 will assist entrepreneurs in starting their own businesses. Similar initiatives will facilitate the communication and spread of new ideas within the water refill sector, promoting its sustained growth. In comparison to other safe drinking water interventions, such as tap water coverage or household water treatment access, there is little data about the potential health impacts of water refill stations.73 In a six month longitudinal study of Indonesian children, it was found that consistent purchase of water from membrane-based refill stations was associated with reduced risk of diarrhea in an urban slum area.74 However, due to the complex interactions between disease transmission and intervention efficacy, these associations must be validated in other areas to ensure these findings were not region-specific. Furthermore, only a randomized intervention study will be able to show whether, controlling for other factors, water refill stations are more or less effective than existing water and sanitation interventions for disease reduction. The enforcement of water quality guidelines will become increasingly important as the number of water refill stations and reliance on them grow. Since many of the refill stations in Southeast Asia operate as private businesses, regulation is a key means of ensuring quality and safety. In 2007, the Philippines’ Department of Health changed national water quality guidelines in recognition of the increased reliance upon water from refill stations, and now requires that all stations be tested once a month to meet minimum WHO guidelines,54 although some claim that this legislation is not being enforced.75 In Indonesia, between 10 and 40% of stations sampled had some bacterial contamination.76,77 A new pilot program started by APDAMIDO (Association of Drinking Water Suppliers and Distributors) in Indonesia seeks to use member-fees to pay for a selfimposed water quality testing scheme that would require each depot to have water quality tested once every 1−3 months.78 This program has faced difficulties because it costs money to station owners and is entirely voluntary. Thus far, only a small percentage of water refill stations have voluntarily joined APDAMIDO,79 with less than 500 out of around 3500 stations
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AUTHOR INFORMATION
Corresponding Author
*E-mail:
[email protected]. Notes
The authors declare no competing financial interest. Biographies Laura C. Sima is a postdoctoral fellow in the Global Water Program in the Bloomberg School of Public Health at Johns Hopkins University. Prior to her postdoctoral position, she was a doctoral student at Yale University′s Department of Chemical and Environmental Engineering where her research addressed decentralized technologies for water and sanitation in developing countries. Menachem Elimelech is the Roberto Goizueta Professor of Chemical and Environmental Engineering at Yale University and Director of the Environmental Engineering Program. His research focuses on membrane separation processes for sustainable production of water and power, environmental applications and implications of nanomaterials, and water and sanitation in developing countries.
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REFERENCES
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NOTE ADDED AFTER ASAP PUBLICATION This paper published June 20, 2013 with an incorrect version of Figure 1 and an incorrect Figure 2 file. The correct version published June 21, 2013.
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