7.4 Potable water supply

7.4.1 Quantity

CTCs and CTUs

A large amount of water is required for:

• The preparation of ORS and human consumption (drinking, cooking).
• Hand-washing and personal hygiene of patients and attendants.
• Cleaning and disinfection of objects, floors, surfaces and laundry.

60 litres per day per patient [1] Citation 1. Organisation mondiale de la Santé. Fiches techniques eau, hygiène et assainissement en situation d’urgence, 2013.
http://www.pseau.org/outils/ouvrages/oms_wedc_quelle_est_la_quantite_d_eau_necessaire_en_situation_d_urgence_2013.pdf  are needed to cover patient, attendant and staff needs as well as cleaning the facility. This volume is given as an indication. Re-evaluate real needs depending on the context (e.g. climate, culture) and the number of patients (the lower the number of patients in proportion to the facility’s total capacity, the greater the quantity of water necessary per day per patient).

It is recommended to have a reserve supply on-site to cover at least 3 days of activity.
For example, for a CTC with 50 patients present:
60 (litres) x 50 (patients) = 3000 litres of water/day x 3 (days) = 9000 litres of water
The CTC needs to have at least 9000 litres of water available every day.

ORPs

Water is needed to prepare ORS and for human consumption (drinking), hand-washing, cleaning and disinfection of objects, floors, surfaces.

Approximately 10 litres of water per patient [2] Citation 2. Oral rehydration points (ORPs): Planning and Guidance. Centers for Disease Control and Prevention 2010. Haiti Cholera Training Resources: Community Health Worker Materials.
https://www.cdc.gov/cholera/pdf/ORP_GuidancePlanning_finalcleared.pdf  are required. This volume is given as an indication; as for other facilities, needs must be re-evaluated depending on the context.

It is also recommended to have a 3-day reserve supply.
For example, for an ORP with 20 patients present:
10 (litres) x 20 (patients) = 200 litres of water/day x 3 (days) = 600 litres of water
The ORP needs to have at least 600 litres of water available every day.

7.4.2 Quality

Water is chlorinated in all treatment facilities (including CTUs and ORPs).
Turbidity should be under 5 NTU. The FRC concentration at all distributions points should be 0.5 mg/litre for a contact time of 30 minutes if the pH is < 8 (and 1 mg/litre for a contact time of 60 minutes if the pH is > 8).

7.4.3 Distribution

CTCs and CTUs

Water is distributed by gravity from a water tower or elevated reservoir via a distribution network equipped with distribution ramps or tapstands placed in each sector.

If electricity is available at all times, a surface pump equipped with an automatic system keeps the distribution network pressurised and distributes water without using gravity (i.e. there is no need to build a water tower or an elevated platform).

It is also possible to organise an entirely manual distribution system. Water is transported in buckets by water carriers that fill 120 litre containers equipped with a tap. These containers serve as distribution points. This system is simple and quick to set up but requires a lot of staff and supervision and should be quickly replaced.

ORPs

The water distribution system is usually manual.

7.4.4 Maintenance and monitoring

Distribution network

The distribution network should be inspected at least twice a month to check there are no leaks and that the valves and taps are working correctly.

Reservoirs (including safety reserve)

Reservoirs should be inspected at least twice a month to check there are no leaks, no deposits (calcium, sand, etc.), that the valves and taps work correctly, and the condition of protective coverings (shade net, roofs) and support frames (platforms, water tower).

For the safety reserve, preferably rotate between the different reservoirs so that the water in reserve is always used and quickly renewed. Before each use, check the FRC level, that tends to disappear within 24 hours. If necessary, re-chlorinate.

Water consumption, water quality control checks, and actions and consumption related to water production should all be recorded in a register of water and sanitation activities (Appendix 3).