Monitoring and Evaluation of 1,000 Households receiving

Ceramic Pot (Kosim) Filters after an Emergency Flood Mass

Distribution in Northern Ghana

Davy Desmyter (Pure Home Water), Abaazan P. Adagwine (Pure Home Water),
Shakool Ibrahim (Pure Home Water), Mary Kay Jackson, P.E. (Pure Home Water),
Susan E. Murcott (Massachusetts Institute of Technology)

Civil and Environmental Engineering Department

Massachusetts Institute of Technology
77 Massachusetts Avenue, 1-138, Cambridge, MA 02139

ABSTRACT

Background: In September 2007, Northern Ghana experienced severe flooding. An

estimated 200,000 people were displaced; both groundwater and surface water
supplies were contaminated. UNICEF-Ghana, sponsored by the European Commission
and with the District Governments, contracted Pure Home Water (PHW) to distribute
5,000 Ceramic Pot (Kosim) Water Filters to affected remote rural communities in the
Northern and Upper East Regions. PHW and the local Environmental Health staff
performed the distribution, an education & training program, and follow-up
monitoring and evaluation of 1,000 households in 23 rural communities 3 to 6 months
later.

Objective: Given that ceramic pot filters were a new type of emergency intervention
for UNICEF, the goal of the monitoring and evaluation study was to learn how the filter
is used and maintained, to determine the community acceptance of the filter and to
ascertain rates of sustained use.

Results: All households were identified by GPS coordinates and all villages receiving
filters were mapped. PHW found that 64% of filters were still in use after 3 to 6
months: 12% of ceramic filters were no longer in use because of a malfunctioning filter
and 24% because of resumed access to improved water sources. Whereas breakage
had formerly been a problem for PHW in long-distance transport, this issue was
resolved when PHW assumed responsibility for transport directly to communities. 95%
of all breakage occurred in the household, with the ceramic pot being the most fragile
element of the ceramic filter unit. 5 % of breakage was of the safe storage container.
To allow the tap to fit in, the plastic container is perforated and is the weakest spot.
Leakage occurred when the tap was incorrectly inserted, typically due to heavy-
handed tap installation. The main reason why households stopped using the filters
(24%) was that their access to an improved water source, such as a borehole or

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protected dug-well, resumed post emergency and/or the availability of rain water
during the wet season. A scoring system rated the success of both the District
Government and the community roles, including also each project phase: distribution,
training and education, treatment and maintenance, monitoring and re-education,
appreciation. Each theme was scored in each community and recommendations for
improvement in future distributions were communicated to UNICEF and have been
posted on-line at: http://web.mit.edu/watsan/meng_ghana/html

KEY WORDS: ceramic pot filters, household drinking water treatment and safe
storage, monitoring and evaluation, emergency, water quality, water supply, Ghana

INTRODUCTION

The Flood: In September 2007, Northern Ghana experienced severe weather

conditions, resulting in massive flooding in the Northern and Upper-East Regions of
the country (Figure 1). An estimated 200,000 people were displaced from their homes
1
and at least 30 people lost their lives due to this natural disaster. Both improved and
2
unimproved water supplies were contaminated by flood waters, creating concerns
about the risk for a widespread outbreak of waterborne disease such as cholera and
diarrhoea, as well as potential for increased cases of Guinea worm in Ghana, which
already has the stigma of being one of the countries with the most cases of Guinea
worm in the world, second only to Sudan.

Figure 1: Northern Ghana Districts affected by the September 2007 floods

1
An improved water supply is: household connection, public standpipe, borehole, protected dug well,
protected spring, rainwater collection.
2
An unimproved water supply is: unprotected well, unprotected spring, rivers/streams/irrigation channels,
lakes/ponds, vendor-provided water, tanker truck water, bottled water.

42
In a well-coordinated emergency response effort, UNICEF, sponsored by the European
Commission and in concert with the Regional Governments, contracted Pure Home
Water (PHW) for the distribution of Kosim Ceramic Pot Filters to the households that
were most affected by contamination of their drinking water supplies due to the
flooding.

Pure Home Water: PHW is a legally registered Ghanaian non-profit social enterprise,
founded in 2005 and located in Tamale, Northern Region, Ghana. The organization’s
aim is to disseminate small-scale, proven technologies for the treatment and safe
storage of water as a complement to other efforts on the part of the government, the
non-profit and private sectors to address water/sanitation/hygiene issues. PHW has
trained field personnel who know how to successfully integrate the Kosim filter and
other household drinking water treatment and safe storage (HWTS) technologies into
homes.

Five thousand Kosim filters were distributed to provide safe drinking water to
households in the flood-stricken rural communities of the East Mamprusi, Zabzugu-
Tatali and East-Gonja Districts of the Northern Region and throughout the flooded
areas in the Bongo, Talensi-Nabdam, Garu-Tempane, Builsa, Kassena Nankana (KNDA)
and Bolgatanga Municipal Districts of the Upper East Region. This paper documents
the results from monitoring the subsequent use of filters in these six Upper East
districts.

3
Kosim Ceramic Pot Filter: The Kosim filter is the Ghanaian version of the Potters for
Peace ceramic pot filter, developed by Fernando Mazariegos in Guatemala in 1981.
PHW has directly sold or distributed this filter to over 11,000 households in Ghana
between 2005-2008. The Kosim filter consists of a ceramic pot, plastic safe-storage
container, top ring, lid, tap, brush, instruction sheet and one Aquatab. If correctly
operated and maintained, the Kosim filter has a proven life span of 3+ years. These
filters are manufactured in Accra, Ghana, about 450 miles south of the flood-affected
areas.
Figure 2: The Kosim Ceramic Filter

3
Kosim is the word for pure water in the Dagbani language, a major local language of Northern Ghana.

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In terms of this filter’s impact, water quality tests performed by Massachusetts

Institute of Technology researchers in Ghana showed an average 99.7% reduction of E.
coli, 99.4% reduction in total coliforms and a 92% reduction in turbidity from the
source water to the filtered water in a one-year follow-up in 41 households. (Johnson
at al, 2007). Health impact studies showed that traditional rural households relying on
unimproved water supplies using the ceramic pot filter were 69% less likely to have
diarrhoea than people without the filter (RR. 0.31, 95% CI, p-value 0.035) (Johnson et
al, 2007). The ceramic filter is also known to remove the cyclops water flea that carries
the Guinea worm larva.

METHODOLOGY

From November 2007 to April 2008, PHW provided 5,000 Kosim ceramic pot filters
together with taps, brushes and PHW/UNICEF informational stickers to UNICEF for
distribution in designated districts in the Northern and Upper East Regions.

PHW procured 5,000 Kosim filters and transported them to Tamale for collection and
distribution by UNICEF from November 2007 until January 2008. The district
government and UNICEF determined which rural communities had been most affected
by the flooding and how many filter units would be reserved for each of these
communities. UNICEF targeted 4 villages in all the districts except KNDA, where five
villages were targeted. The targets were based on a rapid emergency response to
human suffering and the potential for widespread waterborne disease in the area due
to severe flooding.

Then the EHSU staff of the respective districts governments distributed 3,000 Kosim
filters from temporary depots to selected communities during November and
December 2007. Beginning in January 2008, UNICEF contracted PHW to distribute the
remaining 2,000 filters directly to other selected beneficiary communities. This
distribution was completed by April 2008. PHW distributed filter units to 23
communities in 6 designated districts in the Upper East Region: Bolga, Garu/Tempane,
Talensi/Nabadem, Bonga, Kassena Nankana (KNDA), and Builsa (Figure 3).

44
Figure 3: Upper East Districts and Communities Monitored by Pure Home Water

A seventh district, Bawku, was intended, but distribution did not go forward there
because of local civil unrest. Prior to distribution, PHW management and staff
conducted a one-day training of field personnel from Ghanaian Regional
Environmental Health and Sanitation Units (EHSU) on the proper use and maintenance
of the filter. The purpose of the training program was to familiarize the beneficiaries
and the local Environmental Health staff with the basic concepts of proper household
water treatment and safe storage (HWTS). Participants learned about the hazards of
contaminated drinking water and how to properly assemble, operate and maintain the
Kosim ceramic filter unit for maximum effectiveness and longevity. The Environmental
Health staff was also taught how to effectively monitor and, if necessary, re-educate
the beneficiary households.

The EHSU had trained field personnel, familiar with and trusted by the communities to
be reached, who assisted PHW in the process of delivery, acceptance and monitoring
follow-up of the water filters. In addition to the EHSU, PHW liaised with the
Community Water and Sanitation Agency (CWSA), which is the entity responsible for
rural water and sanitation in Ghana and with the Ghanaian Regional Environmental
Health Officer. The responsibility for the filter delivery belonged to PHW, but
assistance from the EHSU Officer and EHSU teams was imperative in order to meet
this obligation. Regular follow-up was the responsibility of these government
organizations, not PHW, as they were based locally and had roots in the communities.
In addition to the government’s ongoing follow-up responsibilities, PHW undertook a
short-term monitoring and evaluation program, spanning the 3-month period from
June through August 2008, and involving the full-time work of 4 PHW staff.

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Three to six months after distribution and accompanied by a local CWSA or EHSU
representative, PHW performed follow-up monitoring at the community and the
individual household level in 23 communities and 1,001 households. The purpose of
the follow-up was to ensure that every individual household had received and was
properly using each individual filter and to reinforce the importance of proper
handling of the filter in order to prevent breakage.

PHW’s overall purpose in carrying out the monitoring and evaluation program was
two-fold: to determine the district governments role in the ceramic filter distribution,
and to follow-up at the household level to determine the community’s and user’s role
in effective use of their ceramic filters. The overall assessment resulted in one page
assessment sheets. Each cover sheet was the District Assessment. Subsequent one
page sheets covered the individual Community Assessments within that district. The
District Assessment was qualitative, based on expert judgment. The Community/user
Assessment was semi-quantitative, following a monitoring checklist of 32 questions.
To assess the district government’s role in each of the districts, PHW interviewed the
government EHSU staff who were responsible for the follow-up and monitoring of the
beneficiaries. Topics discussed during these unscripted interviews were typically:

− government staff appreciation for the ceramic filter;

− monitoring issues encountered by the government;
− availability of resources to perform their monitoring in the field;
− breakage, leakage and product quality issues;
− availability of replacement parts and services;
− requests for distribution in other areas or communities;
− other suggestions and recommendations.

The major insights derived from these District Government and EHSU meetings were
sorted into two themes, compliments and concerns, and a set of recommendations
was developed for each district.

In the beneficiary communities, PHW monitoring visits took place in the compound
where the filter was set up, enabling the PHW monitor to:

− conduct the interview in the environment where the filter is usually operated;
− inspect the filter within its direct surroundings and observe how the
beneficiary operates and maintains the filter;
− re-educate the beneficiary by demonstrating with his/her own filter.

Each script-based interview was a focused session structured around a 32 question

“Ceramic Filter and User Monitoring Checklist” developed by UNICEF-Ghana. The
interview was between the person who usually controls the use and maintenance of
the filter and the PHW monitor and was focused on:

46
 − situational assessment;
− treatment or use of the filter unit;
− maintenance of the filter unit;
− storage of the filtered water;
− appreciation for the filter unit;
− physical inspection or observation of the filter unit;
− re-education of the beneficiary, if needed.

A baseline was not established prior to the filter distribution. Water quality tests of
source water and filter treated water were not conducted. Survey questions related to
health, water-borne illness were not part of the Monitoring Checklist. Because of the
emergency nature of this distribution, neither pairing of users with non-users was
performed, nor were flood victims randomized during distribution or assessment.

PHW monitors were trained to conduct interviews in such a way that:4

− he/she understood the objectives, subject matter and vocabulary of the

survey;
− the beneficiary could comfortably talk with a friendly local, at the same level
and, if possible, in their own local language (there are over 70 local languages
in Ghana, including several distinctly different languages in the Upper East);
− the beneficiary was never interrupted, manipulated or prompted for a certain
answer;
− the beneficiary felt respected and never judged, embarrassed or forced.

At the end of each interview, the monitored filter unit was marked with an original
identification number and mapped using GPS coordinates.

All community data was sorted and assessed according to five main appraisal themes:

Distribution

9 Did the project reach the targeted beneficiaries?

9 Were filters effectively dispersed over the community?

Training & Health Education

9 Did the health education create sufficient awareness about proper household
water treatment and safe water storage (HWTS)?

4
Adapted from: Whittington, Dale. 2002. “Improving the Performance of Contingent Valuation Studies in
Developing Countries” Environmental and Resource Economics 22:323-367, 2002. Kluwer Academic
Publishers, Netherlands

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9 Were the ceramic filter operational & maintenance training concepts

successfully adopted?

Treatment & Maintenance

9 Is the ceramic filter effectively operated and properly maintained?

9 Is the trained beneficiary the dedicated person to control the filter in the
household?
9 What is filtered water used for?
9 Does the household apply other water treatment methods?
9 Is filtered water stored anywhere else in the household?
9 If a given household was not using its filter, what are the main reasons why
that household decided to stop using it?

Monitoring & Re-education

9 Is the Government Field staff effectively and regularly performing the

monitoring rounds?
9 What are the typical re-education topics?
9 What are the most frequently asked questions by beneficiaries?

Appreciation

9 Does the community appreciate the ceramic filter?

9 According to beneficiaries, what are the benefits of using the ceramic filter?

Each theme was evaluated and graded, using following scoring system:

Figure 4: Scoring System for Community Assessment

: EXCELLENT – activity successful

: GOOD – regular follow-up advisable

: PASSABLE – improvement and follow-up advisable

: PROBLEMATIC – reappraisal for alternative solution

: UNSATISFACTORY – suspension of services

The data resulting from these interviews and the observations in the field forms the
basis for the results described below. For each score below EXCELLENT (5/5), general
recommendations as to how short-comings could be overcome, processes improved
or issues resolved were suggested.

48
RESULTS

Monitoring results take three forms: macro results are from an analysis of the 1001
users’ database, District Government Assessments from the qualitative evaluation of
the local government’s role, and Community/user Assessments. The macro results are
depicted graphically in Figures 5 - 9. Figure 5 shows that 56% of users obtain their
drinking water from unimproved water supplies as opposed to 44% who obtain it from
improved supplies. This high percentage of unimproved water supply users makes
sense, given that the UNICEF emergency filter distribution specifically intended to
provide filters to those with unimproved sources and to supply users of improved, but
potentially contaminated, sources with chlorine tablets. That there was still a high
percentage (44%) of users whose water came from improved sources suggests that
targeting to flood victims with unimproved water supplies was only partially
successful.

Figure 5: Percentage Water Source Types among Flood Victims, Upper East, Ghana

56% Unimproved
60 Unimproved
Improved
50 44%
Improved (space)

40 Borehole

Protected Hand-dug
30 Well
Unprotected Hand-
dug Well
20 River, Stream

Dam, Dug-out
10
Pond
0
Other

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Figures 6 and 7 indicate respectively who fetches and who manages the filter within
the beneficiary household. The answer is overwhelmingly women: 87% of women
fetch water as opposed to only 11% of children and 2% of men. And a whopping 96%
of women manage the filter.

Figure 6: Who Fetches Water? Figure 7: Who Manages the Filter?

Figures 8 and 9 indicate that breakage in the home is the leading problem that
households face in using the filter. However, Figure 9 shows that the leading cause of
discontinued use is because of resumption of improved water supply, presumed by
users to be safe. Twenty-four percent stopped using the filter because of this
presumed safe supply, in contrast to 12% who discontinued using the filter over a 3 to
6 month period because of breakage. This rate of discontinued use compares closely
to the high end of rates found in Cambodia by Brown et al. of about 2% discontinued
use per month (WSP/UNICEF, 2007).

Figure 8: % Users with Filter Problems Figure 9: Filters in Use 6-9 Months Later?

The District Assessment results are presented on the following data sheets by giving
one example each of a favorable result and an unfavorable District result. The results
in the Builsa District Assessment are resoundingly positive, while the Bolgatanga
District Assessment is highly negative. These two examples bracket the range of

50
responses received for this evaluation exercise. These data sheets also show the
various components of the assessment. Each includes a map of the district, with
communities identified in their correct GPS location. Next, each sheet has the percent
of filters in use and not in use in that locale. This gives the local government a quick
and easy guide to the success of the intervention. Following the Use/Disuse Pie-chart
Indicator, comes the Compliments, Concerns and Recommendations section.
Compliments range from “exemplary,” “confident mastery” and “fully understand the
benefits of the system” in Builsa District to “appears rather indifferent towards the use
of ceramic filters” in the Bolgatanga District.

Concerns in the Builsa District include a “lack of human resources” and “a serious need
for financial resources to support the mobility of the local staff.”, while in Bolgatanga
District, “we can conclude that virtually no monitoring visits have been performed in
this district; the local staff even turns out to be unfamiliar with the geographical
location of the communities where filters have been distributed.”

Builsa District Assessment

In the Builsa District, PHW interviewed a total of 130 beneficiaries in three monitored
communities: Logvuusa, Kaasa and Yamkpansa.

Ceramic Filter Use

Not In
Use
19%

In Use
81%
Monitored Communities in Builsa District Ceramic Filter Use in Builsa District

Environmental Health Field Staff Interview Summary

Compliments

The Builsa government field staff actively supports the use of ceramic filters in their
district communities. Equal to their colleagues in the Bongo district, the Builsa
government staff is an exemplary role model regarding how the communities that
received the ceramic filters should be effectively monitored. Not only do they show

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the highest field activity levels that PHW has witnessed in the Upper-East region, they
confidently master the operational and maintenance instructions of the ceramic filter
and they fully understand the benefits of the system.

Concerns

Nevertheless the Builsa district suffers from similar deficiencies as its neighbouring
districts in the Upper-East. Next to a lack of human resources, there is a serious need
for financial resources to support the mobility of the local staff. All the same it should
be inspiring for colleagues in other districts to witness the creativity that the Builsa
government staff apply to enable themselves to actively continue their community
services in the field. Finally, during monitoring rounds they found a need for
replacement parts and they advise that filters should be distributed to each household
in every community, not only those that were directly affected by the floods.

Recommendations

A PHW team should revisit the Builsa communities to offer replacement services to
the households that have malfunctioning filter units and to distribute Kosim ceramic
filter units to each household that has not yet received one.

The local government health staff should continue regular surveillance and health
education to support the beneficiaries towards effective use of the system.

Bolgatanga Municipal District Assessment

In the Bolgatanga Municipal District, PHW interviewed a total of 158 beneficiaries in

four monitored communities: Soe Yipala, Dachio, Kumbosco and Kumbangli.

Ceramic Filter Use

Not In
Use
32%

In Use
68%

Monitored Communities in Bolgatanga Municipal District Ceramic Filter Use in Bolgatanga Municipal District

52
Environmental Health Field Staff Interview Summary

Compliments

The government field staff of the Bolgatanga Municipal district appears rather
indifferent towards the use of ceramic filters. Most probably that is due to the fact
that this district did not specifically dedicate field staff to the follow-up of the
communities where ceramic filters have been distributed.

Concerns

Likewise to its counterparts, the Bolgatanga district endures a serious lack of material
resources and motivated human resources, resulting in disrupted and ineffective field
activities. Based on the information acquired during PHW household interviews, we
can conclude that virtually no monitoring visits have been performed in this district;
the local staff even turns out to be unfamiliar with the geographical location of the
communities where filters have been distributed. Therefore no reports, suggestions or
concerns were recorded from district staff. Households do report replacement needs
and put forward mixed feelings amongst community members because some did and
others did not receive a ceramic filter.

Recommendations

A PHW team should revisit the Bolgatanga Municipal communities to offer

replacement services to the households that have malfunctioning filter units and to
distribute ceramic filter units to each household that has not yet receive one.

Furthermore a number of dedicated local government field staff who are familiar with
the communities that received ceramic filters, should be selected and trained to
perform monitoring visits and health education and to convince the beneficiaries to
continue to use the filter effectively.

Balungu Community Assessment, Bongo District

Population 544 Distribution Date: 8 February 2008

No:
Household 102 Distribution No: 32
No:
Compound 65 Monitoring Date: 18 June 2008
No:
Water stream, borehole Monitored 24
source(s): Household No:

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Not In Ceramic Filter Use

Use
4%

In Use
96%
Monitored Households in Balungu Ceramic Filter Use in Balungu

Distribution score:

Observation: The distribution was successful, although more filters should have been dispersed
to cover every flood-affected household in this community. Certain households received more
than one filter to serve the numerous family members, while other households could only
observe in disappointment.

Training & Health Education score:

Observation: The health education and operational & maintenance training turned out highly
successful.

Treatment & Maintenance score:

Observation: Filters are excellently handled and properly maintained on a regular basis. The
trained beneficiary is usually the person who is dedicated to controlling the filter unit. Due to
scarcity, filtered water only serves for drinking purposes. The households in this community do
not apply methods other then the ceramic filter to treat their drinking water. The storage
container of the ceramic filter is the only safe water storage vessel in these households.
Malfunctioning filters are the single reason for discontinued use in this community.

Monitoring & Re-education score:

Observation: The government field staff is doing an outstanding job. Monitoring rounds are
performed on a regular basis and the little re-education that is necessary in this community is
focused on the location and hygienic use of the drinking vessel, the position of the ceramic
filter unit in the compound, the cleaning and frequency of cleaning of the ceramic pot and the
overfilling of the safe storage container. Frequently asked question: Where can I find
replacement parts?

Appreciation score:

54
Observation: The households in this community are very grateful for receiving the filters and
cheerful because of our monitoring visit. Beneficiaries say they have now become inseparable
from their filters because they are no longer troubled by abdominal pains and diarrhoea;
furthermore the quality and taste of their drinking water has significantly improved. Those
with malfunctioning filters are eagerly asking how they can repair their filter. Households that
did not receive a filter are trying to convince PHW to bring more filters soon.

Buarboka Community Assessment, Garu Tempane District

Population 2138 Distribution Date: 3 March 2008

No:

Household No: 304 Distribution No: 64

Compound No: 256 Monitoring Date: 19 June 2008

Water hand dug well, borehole, pipe Monitored Household 6

source(s): No:

Ceramic Filter Use

Not In
In Use
Use
50%
50%

Monitored households in Buarboka Ceramic Filter Use in Buarboka

Distribution score:

Observation: The distribution in this community turned out to be disastrous as most of

the filters missed their target beneficiaries because they were distributed on a market
day and so ended up in the homes of visitors from nearby communities that were
unaffected by the floods. Out of sixty-four filters distributed, only a fraction were found
here; it is not clear where the other filters are.

Training & Health Education score:

Observation: Similar to the distribution, both the training and health education are
deemed highly unsuccessful.

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Treatment & Maintenance score:

Observation: The few filters found in this community were poorly handled and maintained.
Due to scarcity, filtered water is only used for drinking purposes. Households in this
community generally do not treat drinking water; furthermore they see no reason why
they should use the ceramic filter. For those that do use the filter, the storage container of
the ceramic filter is the only safe water storage vessel. Reasons for discontinued use are
breakage, leakage and a general disinterest for the system.

Monitoring & Re-education score:

Observation: The government field staff is not executing the monitoring rounds.
Unfortunately, the first monitoring visits were performed by the PHW team. Not
surprisingly the government field staff was unaware of the unfortunate situation in the
field. Re-education during the PHW monitoring round was focused on all training and
health education topics.

Appreciation score:

Observation: The households in this community have no interest nor display any curiosity for
the ceramic filters.

The last two data sheets are from the Community/User Assessments. Again both
favorable and unfavorable results have been presented: the Balungu Community
Assessment and the Buarboka Community Assessment, respectively. The favorable
result from Balungu, a community of 102 households, is one where only 4% of filters
are not in use. Assessments here are in glowing terms. “Filters are excellently handled
and properly maintained on a regular basis.” “The government field staff is doing an
outstanding job.” “Monitoring rounds are performed on a regular basis and little re-
education is necessary.” Compared to Balungu, the community of Buarboka is
seriously lacking. “The distribution in this community turned out to be disastrous as
most of the filters missed their target beneficiaries.” “The government field staff is not
executing the monitoring rounds. Unfortunately, the first monitoring visits were
performed by the PHW team. Not surprisingly the government field staff was unaware
of the unfortunate situation in the field.”

DISCUSSION/RECOMMENDATIONS

The widespread distribution of a large number of filters in a relatively short period of

time, followed by comprehensive monitoring and evaluation of sustained use provides
a wonderful opportunity to acknowledge program successes, strengthen program
short-comings and learn from program failures. All of the recommendations that
came out in the monitoring and evaluation are being seriously reviewed by both
UNICEF and PHW and implemented in a new filter distribution program in two new

56
districts as of January 2009. Below we discuss key recommendations, solutions and
plans for new distributions.

Distribution

Issue: The local Government Environmental Health officers were responsible for the
selection of the target beneficiaries. They assessed the situation in the field and
investigated which communities and specifically which households in those
communities had been worst hit by the floods. Subsequently they advised UNICEF on
the number of filters needed and where exactly these should be delivered. UNICEF
then contracted PHW to join the government staff in the field for the health
education, training and finally the distribution. Unfortunately the government field
staff never prepared a list of beneficiaries before the actual distribution phase. In
many communities this resulted in a rather ad hoc selection of beneficiaries at the
moment of the distribution itself; those that were fast enough to register their name
as ‘beneficiary’ received a filter. Additionally, in most communities the number of
flood-affected households greatly exceeded the number of available ceramic filters.
This limited number of filters often ended up poorly dispersed, sometimes clustered in
less flood-affected areas of the community, and often those families that were
impacted the most were left without this much-needed intervention.

Possible Solutions: During the assessment phase, before the filters actually arrive in
the community, the government field staff should carefully identify and map the most
affected community area(s) and list the households that live there as ‘targeted
beneficiaries.’ The number of listed households then determines the exact number of
ceramic filters required for that community. Subsequently, in the distribution phase,
this list will guide the team to accurately disperse the filters to the right people.

Another approach would be to completely blanket target communities, insuring that

every household received one or more filters, depending on family size. Again, the
government field staff should map the area and count the households to make sure
that a sufficient number of filter units are delivered to the community.

Plan for Next Distribution: For the next UNICEF distribution, PHW has been asked to
provide filters for every household in the beneficiary community. PHW will work
closely with the government field staff to make sure that enough filters are delivered
to each community to meet this blanket demand. In addition, PHW will distribute the
filters by going from household to household, rather than handing out filters at a
centralized location. In this way, PHW hopes to keep distribution to the target
community and avoid unplanned distribution to households in neighboring
communities.

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Training & Health Education

Issue: In each community, beneficiaries were assembled in a large group to attend a

standard, one-way health education and filter training; ‘standard’ because every
community received the same training and ‘one-way’ because this training generally
instructed the beneficiaries without allowing much space for interaction or exercise.
This method resulted in less-effective trainings.

Solution: Trainings should be conducted with small groups of beneficiaries, enabling

the trainees to interact during the training process and allowing them an opportunity
to perform easily understood and practical exercises that will familiarize them with the
basic concepts of proper household water treatment and safe storage, the hazards of
contaminated drinking water, and how to properly assemble, operate and maintain
the ceramic filter for maximum effectiveness. Training programs should vary based on
community specific situations, e.g. many beneficiaries that are fortunate enough to
have access to improved water sources in their community, will shortly after the flood-
affected water source has been decontaminated, stop using the ceramic filter because
drinking water taken from that source is then considered clean. For such communities,
the training should educate the beneficiaries on the benefits of filtering not only
unimproved water supplies, but also improved water supplies such as borehole and
rain water, also on how to use the Kosim filter safe storage container for safe drinking
water storage. Moreover, the concept and use of AquaTabs could be introduced and
distributed in the community.

Plan for Next Distribution: For the next UNICEF distribution, PHW will conduct training
sessions for small clusters of adjacent households, probably 5 to 8 households at a
time. Training has been updated to include a segment on the benefits of continuing to
use the filter even on perceived “safe” sources of water.

Discontinued Use

Issue: 6 to 12 months after the distribution, some ceramic filters are no longer in use.

12% because of a malfunctioning filter. While the breakage rate is 12% in aggregate, it
is as low as 5% and as high as 45% in specific communities.

24% because of access to improved water sources or other reasons

(i) Malfunctioning Filters

Breakage

95% of all breakage occurs with the ceramic pot (a fired clay pot), the most fragile
element of the Kosim ceramic filter unit. If not handled with care, one can easily break

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or crack the pot rendering it useless: a cracked or broken pot will no longer effectively
filter the water. Although the whole pot is fragile and will break if dropped to the
floor, the weakest spot is definitely the lip (the part that allows the pot to rest on top
of the ring lid). Lip breakage usually happens when the ceramic pot is not gently
handled or can occur when it is lifted out of the safe storage container while it is filled
with water, then the weight can be enough to break off the lip. Breaking the lip does
not always destroy the pot, but it does create a gap between the ring lid and the
ceramic filter, allowing unfiltered water to contaminate the filtered water inside the
safe storage container; lip breakage can also create cracks in the sides of the ceramic
pot, making it useless as it will no longer effectively filter the water.

5% of all breakage occurs with the plastic safe storage container. To allow the tap to fit
in, the plastic container has been perforated. It is this perforation that forms the
weakest spot of the safe storage container. If during the installation, the tap is
tightened too hard in the perforation of the storage container, there is a chance that
the plastic of the container cracks and as a result starts leaking water.

Leakage

Leakage usually occurs when the tap is incorrectly inserted in the perforation of the
safe storage container. As described above, some filters may start leaking when a
heavy-handed tap installation results in a cracked container; although most filters start
leaking because of incorrectly or incompletely installed tap washers. Washers are two
rubber rings that closely secure the tap in the plastic safe storage container; they are
specifically made to prevent leakage, but if incorrectly installed, they may be the cause
of leakage.

(ii) Access to improved water sources

Clearly the main reason why households stop using the ceramic filter, is the access to
an improved water source such as a borehole, a protected hand dug well or pipe
water; or the availability of rain water during the wet season. Improved water sources
may be temporarily inaccessible due to contamination as a result of a natural disaster
or malfunction; once they are restored to their useful condition, households will revisit
them as their most preferred source of drinking water. Some households have
installed primitive rainwater harvesting systems in their compound. With the arrival of
the wet season, many of these households decided to stop using their ceramic filters,
at least temporarily and unfortunately some permanently, preferring to consume the
untreated rain water. Naturally, water that originates from such rain water sources
usually appears clean to the eye, easily convincing the beneficiary that further
treatment is pointless.

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 International Ceramic Pot Filter Workshop | WEF Disinfection 2009 | February 28 | Atlanta

Solution:

(i) Malfunctioning Filters

Pure Home Water and their partners at Massachusetts Institution of Technology and
the World Health Organization-hosted International Network to Promote Household
Drinking Water Treatment and Safe Storage, should further research ways to reduce
or eliminate breakage in use and to implement their findings as quickly as possible in
order to provide beneficiaries with a product that is less fragile.

Most ceramic filter units malfunction because they are not properly handled;
marginally few because of fatigue failure. Just like many other devices, the ceramic
filter unit contains elements that are fragile and will break if not handled with care.
Prevention is therefore crucial in order to minimize the potential for malfunction. The
best approach for prevention is definitely to deliver a relevant and comprehensible
education and practical training to the person who will control the ceramic filter unit.
In addition to protecting the beneficiary household by teaching them how to use the
ceramic filter to properly treat and store household drinking water, the enhanced
utilization practices resulting from a successful training should also maximize the
longevity of the ceramic filter unit.

No matter how successful the training or how careful the beneficiary, accidents
happen and filters get broken or start leaking. Ideally, these malfunctioning filters can
be quickly repaired so that households can continue to enjoy safe drinking water.
Unfortunately, households with malfunctioning filters currently have no access to
replacement parts or services. As the government field staff are expected to monitor
the beneficiary households on a regular basis, they are in the ideal position to list the
required replacement parts for each household and each community. One approach
could be for a certain percentage (e.g. 15%) of extra filters to be provided at the time
of delivery to each District Environmental Health Directorate. Alternatively, after
reaching a certain quota of malfunctioning filters, the Government Field staff can
notify PHW to deliver the required replacement parts to the District Environmental
Health Directorate, from where they can then be further allocated in the field by the
Government Field staff.

In order to further improve the effectiveness and durability of the Kosim ceramic filter,
PHW communicates regularly with counterparts and experts around the world. The
most important issues are currently the fragile lip of the ceramic pot and the weak
area around the perforation in the plastic safe storage container. Obviously, PHW
would like to make the whole ceramic pot less fragile, but it is the nature and purpose
of its components (clay and sawdust or rice husk) that makes this part so brittle, yet
highly effective. Further improving on the fragility of the whole ceramic pot may be
unlikely, though following a recommendation by an international expert, PHW will

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soon advise its ceramic pot manufacturer to make the lip of the ceramic filter
considerably stronger by increasing the thickness from ½” to ¾”. In cooperation with
the manufacturer of the plastic container, PHW is also investigating how to make the
safe storage container more durable.

As the different elements of the Kosim ceramic filter are supplied by various
manufacturers, sporadically it happens that one or more elements do not meet the
prescribed quality standards, sometimes resulting in incompatible product elements
and therefore a malfunctioning ceramic filter unit. PHW has no hands-on control in the
fabrication process; although it does advise its manufacturers how to improve on each
product component. In order to guarantee end-users a quality product, PHW strives to
effectively integrate these different elements with the help of a dedicated Quality
Control Officer. This person is committed to investigate and resolve each product
anomaly in concert with the manufacturer of the part.

(ii) Access to Improved Water Sources and other reasons for discontinued use

Evidence from studies around the world have shown that access to an improved water
supply does not necessarily guarantee a safe drinking water – that water can become
contaminated in transit and through unhygienic household water management and
storage practices. It is therefore important that hygienic household water
management and treatment processes become the norm for ALL households,
regardless of whether they are drinking from improved or unimproved water supplies.
If households are discontinuing the use of ceramic filters seasonally, because of the
availability of improved sources, they should be encouraged to continue their
practices of treating and safe storage of water with their Kosim ceramic pot filter. If
households are discontinuing the use of ceramic filters permanently, these filters
should be redistributed to others who can benefit.

In most cases the interviewed beneficiaries decided to stop using the ceramic filter
because they did not sufficiently realize the benefits of providing their households
with treated drinking water. Convincing them to continue to use the ceramic filter,
starts with an effective health education training, followed by monitoring and re-
education visits at regular intervals, allowing Government field staff to reiterate these
benefits where deemed necessary. If trainings are successful and monitoring rounds
are properly executed, then the number of ceramic filter users is likely to be
significantly higher and more stable, then what it is now, even in communities with
access to improved water sources.

Plan for Next Distribution: Experience has shown that the further down the delivery
chain that PHW staff are involved, the lower the breakage rates that are experienced.
This in part explains the widely varying breakage rates between individual
communities, as PHW staff may have been more or less engaged in the distribution

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 International Ceramic Pot Filter Workshop | WEF Disinfection 2009 | February 28 | Atlanta

and installation of filters in an individual community. For the next UNICEF distribution,
PHW will install the filter in each household, in an attempt to reduce the breakage and
leakage rates of filters. PHW staff will have spare parts on hand, so that if there is a
problem identified at the time of installation, it can be immediately corrected. In
addition, an allowance has been included in the budget for spare parts which can be
left with the local monitoring staff, so that as problems occur in the field, parts are
available to repair the filter unit or replace the broken filter pot. Finally, PHW and
government field staff training will emphasize the benefits of continuing to use filters
even on presumed “safe” sources of water.

Monitoring & Evaluation

Issue: In several districts, the monitoring & evaluation is not regularly (or not at all)
executed by the government field staff. As a result of this important lack of support in
the field, a large number of beneficiaries stopped using or were over time no longer
correctly using the ceramic filter unit.

Solution: It appears that the main reason why most government staff minimized its
efforts in the field is a serious lack of financial, material and human resources. For
future projects at least a part of the government expenditure for ceramic filter
monitoring should be budgeted and reimbursed. Monitoring, evaluation and re-
education are extremely important to the overall success of ceramic filter
implementation projects and should therefore be properly and regularly executed.

Plan for Next Distribution: For the next UNICEF distribution, PHW will work closely
with the government field staff in the two target districts to build their capacity for
ongoing monitoring and evaluation. In addition, UNICEF has supposedly included
funds in the district contracts to support this effort.

CONCLUSIONS

All 1001 Upper East Region households Pure Home Water assessed over the three
month monitoring period from June to August 2008 were identified by GPS
coordinates and all villages receiving filters were mapped. PHW found that 64% of
filters were still in use after 3 to 6 months: 12% (in aggregate, but with a range of 5%
to 45%) of ceramic filters were no longer in use because of a malfunctioning filter and
24% because of resumed access to improved water sources. A scoring system rated
the success of both the District Government and the community roles, covering each
project phase: distribution, training and education, treatment and maintenance,
monitoring and re-education, appreciation. Each theme was scored in each
community and recommendations for improvement in future distributions were
communicated to UNICEF and posted on-line at:
http://web.mit.edu/watsan/meng_ghana/html

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LIST OF ABBREVIATIONS

Community Water and Sanitation Agency CWSA

Household drinking water treatment and safe storage HWTS

Kassena Nankana District Assembly KNDA

Pure Home Water PHW

Regional Environmental Health and Sanitation Units EHSU

REFERENCES

Johnson, S. Health and Water Quality Monitoring of Pure Home Water’s Ceramic Filter
Dissemination in the Northern Region of Ghana. Massachusetts Institute of
Technology, Civil and Environmental Engineering Dept., Master of Engineering Thesis.
June 2007. http://web.mit.edu/watsan/project_ghana.htm

WSP/UNICEF. Use of Ceramic Water Filters in Cambodia. Field Note. August, 2007

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