An assessment of long-term biosand fi lter use and sustainability in the Artibonite Valley near Deschapelles , Haiti

A non-randomized assessment of long-term biosand filter (BSF) use and sustainability in the Artibonite Valley near Deschapelles, Haiti was conducted during March, 2011. Of the 55 BSFs visited, 47% were no longer in use. Filter lifespan ranged from <1 year to systems still in use after 12 years. Interviews with BSF owners revealed problems related to intermittent filter use due to travel for employment or personal matters; broken or missing filter parts; and fears that the filter would not be effective against cholera. In addition, 17 BSF field studies were reviewed to identify common issues impacting usage. Culturally appropriate technologies and education materials explaining proper maintenance and operation are essential for improved filter performance and sustainability. For Haiti, education materials should be provided in Creole and French and should include, (1) diagrams and descriptions of how the BSF works, (2) how to troubleshoot common problems, (3) how to properly maintain filters, and (4) a contact in case of questions. Operational problems can be minimized by providing long-term technical support, periodic water quality monitoring, and maintenance assistance for filter users. doi: 10.2166/washdev.2013.092 s://iwaponline.com/washdev/article-pdf/3/1/51/384588/51.pdf Andrew J. Sisson (corresponding author) Annis Water Resource Institute, Grand Valley State University, 740 W. Shoreline Dr. Muskegon, MI 49451 E-mail: sissonaj@gmail.com Peter J. Wampler Department of Geology, Grand Valley State University, 1 Campus Dr. Allendale, MI 49401 Richard R. Rediske Annis Water Resource Institute, Grand Valley State University, 740 W. Shoreline Dr. Muskegon, MI 49451 Azizur R. Molla Department of Anthropology, Grand Valley State University, 1 Campus Dr. Allendale, MI 49401


INTRODUCTION
Over 780 million people world-wide lack access to safe drinking water sources (World Health Organization/ United Nations Children's Fund [WHO/UNICEF] ).
Contamination of drinking water through poor sanitation and hygiene is a major health risk in underdeveloped countries and is responsible for 88% of diarrheal disease in the world (WHO ). In the Republic of Haiti, child mortality rates are 15 times higher than in the United States, largely due to inadequate access to clean water, proper sanitation, and hygiene (WHO ). While some strides have been made toward providing improved, safe drinking water sources to Haitians since the 1990s, 49% of rural Haitians still use unimproved sources for drinking water (WHO/UNICEF ).

RESULTS
Of the 55 households visited, 26 filters were not in use.
Nearly two-thirds (65%) of non-functioning filters were reported as in use for less than seven years ( Figure 2). Primary reasons leading to filter disuse are summarized in Table 1. BSF owners mentioned difficulty using the filters daily due to frequent prolonged travel to larger cities for work or hospital visits (n ¼ 5). This eventually led to sporadic filter usage and abandonment. In two cases, a broken collecting bucket spigot was mentioned as the reason for stopping use. One owner claimed the January 2010 earthquake caused the filter to fall and break, while another owner stopped using the filter because the lid broke. In two of the cases, filters were installed but never used. Filter owners said the filter was provided free of charge, but they were required to buy their own bucket as a way of encouraging ownership of the filters. In a third case, a bucket was supplied as part of a year-long trial period but after it broke, filter use was discontinued. Each of these households said they could not afford a new clean water bucket which costs ∼160 Gourde ($4 USD).
Ant infestations occurred in two homes where owners mentioned using filters only once a week. Filter clogging was mentioned in three homes that used hand dug wells which resulted in reduced flow rates and led to filter neglect or malfunction. BSF owners, on average, claimed to clean their filters 2-3 times per year but answers ranged from never to almost weekly. Several owners mentioned cleaning only occurred when a filter technician came to visit. The cholera outbreak in December 2010 was the reason three households stopped using their filters, stating they were told not to rely on the BSF to protect against cholera.
These users bought treated water instead. Reasons for stopping use were not given for two filters and chlorination of source water was given once.
An additional concern mentioned on four occasions involved chlorination of water prior to filtration. In one case, the homeowner had stopped using his filter two weeks prior to our visit as a result of smelling chlorine in his water. The source water in this case was a capped spring which was piped to a large reservoir. After the cholera outbreak, a local NGO added a chlorine dispenser to the reservoir without informing the HAS community development center, who originally built the reservoir, or the community members. HAS records showed as many as 20 BSFs could have been affected by reservoir chlorination.
The three remaining cases were in a different community where filter users were adding chlorine tablets prior to filtration.
Many issues, related to sustainability and effective use, were in agreement with previous studies. Factors affecting sustainable and effective BSF use from studies in 14 different countries included improved BSF owner education; poor understanding of the linkage between water quality and sanitation; source water causing filter clogging; water recontamination due to animal or human contact; and inadequate maintenance ( Table 2).

DISCUSSION
We recognize that some error is likely associated with the duration of filter use, as it was determined by user reporting, but note that exact installation dates were obtained from implementing organizations for all but one of the non-functioning filters and that this does not interfere with the issues given for filters no longer being used. It is also important to note that while 47% of filters were non-functioning at the time of this study, all but one (broken beyond repair) could be brought back into use with biofilm re-establishment and/or other minor maintenance. Our sample size was comparable to previously published studies on BSF use (median ¼ 67.5, Table 2

Cultural sensitivity and BSF suitability
In order for BSFs to be properly and reliably used they must be placed in settings where BSF use is compatible with source water and cultural practices. Some of the most commonly observed problems leading to filter disuse in Haiti were associated with Haitian culture, lifestyle, and beliefs.
Haitians commonly mentioned the incompatibility, or difficulty of continually using the BSF due to the travel requirements of their lifestyle.
A similar problem leading to the disuse of several filters was noted in the Dominican Republic (Aiken et al. ).
Several BSF owners noted they had stopped using their filter because they regularly spent extended time away from home, and it became a nuisance to maintain the recommended charging and maintenance regime for proper biofilm function. For many rural Haitians, their lifestyle includes extended periods of time away from home for work, personal or family illness, or visiting family and friends. Intermittent use may pose a health risk to users whose biofilm is not regularly maintained. In such situations, BSF owners should allow for a (re)start-up period in addition to utilizing post-filter chlorination to disinfect water before drinking. Bottled water also could be consumed during the start-up period. While unexpected travel due to illness and work may not be predictable by BSF distributors, having a good understanding of the culture and lifestyle of the target users will result in providing the most appropriate water treatment technology (Sobsey et al. ).
Survey results from our study indicate that there is still a lack of understanding of the connection between water and illness, and how the BSF functions to prevent water-borne An unfortunate reality is that NGOs, implementers, and stakeholders often struggle for ways to convince funders that long-term monitoring, evaluation, and technical support are not financial black holes, but these efforts are equally valuable in the effective and sustainable installation of POU treatment devices (Gadgil & Derby ). It is generally accepted that sustainable public health systems and education require ongoing contact with the people they serve, but this is often an inconsistent feature of water and sanitation projects.
Many of the problems observed in Haiti were not due to neglect or lack of effort from the implementing organizations.
Many of the recommendations made here were implemented but had to be discontinued due to lack of funding. In Haiti, governmental agencies and NGO's have started working together through the DINEPA and WASH cluster programs to address water, sanitation, and hygiene needs. Hopefully these collaborations will continue and expand to include more academic institutions in Haiti and abroad.
Lastly, understanding water resources from an ecological, biological, geological, and anthropological context by region is needed to ensure that suitable water interventions are implemented. Every year, thousands of new BSFs are shipped around the world to remote communities. A generalized distribution plan is unlikely to meet the individual needs of all the families in the region and provide a sustainable solution to clean water needs. Incorporating scientific studies, observations, and recommendations in these efforts, especially in the area of culturally appropriate education, follow up, and maintenance will make sure these efforts are effective. Additional thanks to Jarod Kohler for help in conducting and filming all of the field research.