Programs and results

What we aim to solve

SOURCE: Self-reported by organization

n remote African villages lacking power, drinking water is derived from surface water often polluted by feces containing multiple pathogenic species, coliforms and viruses, major causes of life threatening diarrhea, particularly in children. Handwashing facilities are generally unavailable. These circumstances lead to widespread acute and chronic illness, and disability. Girls often retrieve water from sources contaminated with Schistosoma absorbed through the skin resulting in Schistosomiasis and chronic ill health.

Current methods for reducing the pathogen load include water boiling, ineffective filtration devices and buying sachet water. Access to pure water in these villages have been unsuccessful because of the relative absence of adequate roads and only the availability of small capacity boats, making the transport of materials difficult, including equipment to dig boreholes. The result is morbidity and early mortality due to the inability to obtain sufficient purified water.

Our programs

SOURCE: Self-reported by organization

What are the organization's current programs, how do they measure success, and who do the programs serve?

The drinking of water polluted with fecal material leading to diarrhea is the second most common cause of death worldwide in children younger than five. The absence of sanitation and of effective hand washing also contribute to the high incidence of diarrhea. Easy Water for Everyone (EWfE), a US NGO, brings an innovative water-purifying device to isolated villages that have no electricity or other power supply to filter the villages’ contaminated water from rivers, streams, lakes, wells and boreholes, and changes it into pure water ready to drink!

Population(s) Served

Economically disadvantaged, low-income, and poor people

Infants to preschool (under age 5)

Charting impact

SOURCE: Self-reported by organization

Five powerful questions that require reflection about what really matters - results.

What is the organization aiming to accomplish?

Easy Water for Everyone (EWfE) aims to provide pure water for drinking, cooking and hand washing without chemical agents using a non powered device (Gravity Water Station (GWS)) consisting of 8 repurposed hemodialyzers each containing ~ 12000 polysulphone hollow fibers with pore sizes of 0.003 microns, excluding viruses and bacteria to purify fecally contaminated water. EWfE’s GWS is a 50 times smaller version of an Israeli device used to purify sewage for irrigation and drinking water. This version operates by manual pumping or gravity flow with production rates of 500L/hr or 250L/hr, respectively. The GWS asset life is 5 years, with the hemodialyzers replaced ~ every 2 yrs at a cost of ~$8 ea. While the initial goal (in conjunction with the International Society of Nephrology) was to treat kidney failure in children following exposure to contaminated water by peritoneal dialysis, while awaiting return of kidney function, the emphasis has now changed with the application of this technology which meets the challenge of preventing severe diarrhea, the major cause of circulatory collapse and acute kidney failure, by providing a source of pure water. The rates of diarrhea pre- and post-GWS implementation were determined by regular household visits and clinic record reviews from 6 months or more. Based on the data collected since the first GWS systems were placed in, there has been a ~ 70% reduction in diarrheal incidence in villages which used the GWS (Scientific Reports (Nature)/ (link: https://rdcu.be/b5rPt)).

The educational aim of the introduction of the technology is to achieve a complete understanding by the villagers of the key concepts for the project to decrease the incidence of diarrhea. This includes use of purified water in the home but also in close by schools, or on the rare occasion, when a small health clinic is in the area. EWfE purposely involves the schools through the headmaster and teachers as to its aims. Goals are for a comprehensive approach for the production and utilization of purified water and the improvement of outcomes. EWfE continues to implement another component of its aims which was for each village to install central handwashing stations, largely completed at this time. EWfE conferred with village leaders to participate in educational activities relating to handwashing and its appropriate applications. EWfE also has the aim through the train the trainer program, to provide employment opportunities to some villagers, who can contribute to assist in further expansion of the project, lending stability and future economic improvement, with a healthier village population. It is the aim of EWfE to scale up its operations to the need in the vastly underserved villages in Sub-Saharan Africa. EWfE has shown a predictable improvement in health as a result of higher quality of water and with enthusiastic acceptance by villages and local authorities, which were and are its aims.

What are the organization's key strategies for making this happen?

To accomplish the goal of providing pure drinking water in remote villages with contaminated water sources and no power, EWfE has developed the following strategies:

1) Initiation with joint participation. EWfE relied on nephrologists in Ghana and Uganda to locate villages recognized as having significant diarrheal illness in children. In the first 3 installations, Professor Sampson Antwi, Kumasi, Ghana introduced the GWS to tribal leaders and local government and traveled with EWfE for the actual installations in May of 2015. This joint participation laid a foundation for the future success of the establishment of this technology and united the EWfE staff with the villagers. EWfE continues with installations in the Kumasi area.

2) Joint participation to expand. The next group of sites was developed on the estuarial islands of the Volta River which followed an introduction by a US-Ghanaian nurse with many connections on the islands. EWfE has established 13 of 25 island sites and is continuing in 2022.

3) Participation with other organizations. Subsequently EWfE has partnered with the following NGOs: Swiss/Ghana waterforeveryone; Uganda/Germany WeDev; USA/Senegal-LeKorsa; and Ghanaian - ADPO. These types of partnerships, together with regional NGOs, will continue as an essential strategy for future expansion. They are ideal since the partnering NGOs, in all these instances, have already established a relationship in the village(s), some for many years, which streamlines the entire process from the introduction of the water purification technology all the way to independent operations. The GWS is integrated into their local administrative responsibilities thereby stabilizing the future of both their and EWfE’s activities, financially and operationally.

4) Obtain resources to scale up implementation. As the project moves forward, the above strategies are necessary, but are not sufficient, for EWfE to scale up to its maximum potential. To do this, external resources are needed. EWfE in the past 2 years has been seeking larger NGOs, private and corporate donors, private foundations, government agencies, and universities with a focus on water. The goals are to expand the number of sites, but also to collaboratively use research-based evidence of effectiveness to drive further resources and expansion. The latter approach includes assessing the effect of decreasing the incidence of diarrhea on mortality, on hospital admissions, the effects on the local economy, school attendance and its subsequent benefits, impact on disability-adjusted life-years (DALYs), and fertility, etc.

The strategy of working with organizations that have more sophisticated and wider global and scientific impact should allow EWfE to achieve its goal of bringing pure water to the target populations, not only by bringing better overall health to the villagers but also enhancing their ability to contribute to the economy, for the greater good of their countries.

What are the organization's capabilities for doing this?

EWfE’s strongest resources are human. A remarkable group of personnel at all levels have made possible EWfE progress emphasizing joint work with in-country experts. The board members and advisors are: Nathan W. Levin, MD, nephrologist; Linda L. Donald, MA, finance/operations; Seth Johnson, RN, nurse educator (and former Ghanaian); Jochen Raimann, MD, epidemiologist; Sampson Antwi, MD, pediatric nephrologist and Daniel Ansong, MD, medical school Dean, both Ghanaians. EWfE’s expertise originated in the US but, a transfer to a Ghanaian/African staff has occurred i.e. technical, administrative (accounting, marketing, etc.), clinical, research and educational functions. The goal is self-sufficient African operations collaborating with their US counterparts to achieve future objectives. A train the trainer model is the main resource that helps EWfE to meet its functional goals. For example, EWfE hired an advanced PhD student to administer the activities listed above for the first 3 sites. Data collectors and data entry personnel were available for EWfE’s use. There was a need for a technical assistant in each of the 3 villages to be trained for performing maintenance functions of the GWS such as backwashing the polysulphone membrane filters 3 times/day and filling the 1000 liter overhead tank (using a small gasoline pump) with contaminated water.

The technical assistant was chosen by the village committee. Once the original 3 sites were functioning well, a determination was made to open additional sites. At that point, a person with exceptional technical skills became available, who, together with the others, formed the nucleus of the Ghanaian-based EWfE staff. A Director of Operations for Africa and the establishment of a formal office was now needed, replete with accountant, monitoring & evaluation (M&E) expertise, educators, and social media. Currently, 41 persons are working for EWfE in various capacities, all having been trained for their respective jobs by either the US team or now the senior administrative or technical staff in Accra, Ghana. The Ghanaian team has produced a detailed technical training manual in conjunction with the manufacturer and the US team, to ensure that as expansion in Uganda and Senegal occurs, consistency of the process is assured. An education manual which included pre-installation training for the village leadership, the villagers, proximate schools, and health clinics, to cover the scientific aspects of how the GWS removes viruses, bacteria, and parasites and why clinically this is vital to the health of people, especially children under the age of 5. It is important to note that the US team over the past 7 yrs has been able to travel to Africa several times a year (not 2021) in order to work directly with the team in Ghana and the new sites in Uganda and Senegal. EWfE believes it can continue through vigorous train the trainer programs to attract many individuals to lead and expand the work in Sub-Saharan Africa.

What have they accomplished so far and what's next?

Between May 2015 and July 2022, the number of villages with installed GWS providing pure water in villages without power or sanitation have increased from 3 to 25. 23 are in Ghana and 2 in Uganda. Together, these have improved the lives of ~17000 people and reduced the incidence of diarrhea and of mortality. In addition, 6 GWSs are currently being installed in Senegal in 3 villages and 3 schools. As mentioned earlier, presentations have been made at scientific meetings and a paper describing the benefits of water purification appeared in Scientific Reports-Nature. Comments from scientists have uniformly been favorable and highly supportive of the methodology.

In a further effort to improve communal health, handwashing stations have been installed in the 24 villages with the intention of further reducing the incidence of diarrhea. Relevant studies to assess consequences are underway. The stations use GWS water combined with soap on a rope, and the endeavor is supported by appropriate education in the classroom, clinics, in bulletins broadcast by the local radio stations and educational posters displayed with the GWS, stressing the health benefits to students and parents of handwashing. The ability to provide pure water and the appropriate technology for handwashing adds a significant prophylactic element to health maintenance in the village.

EWfE’s planned economic model requires that the village supports the upkeep of the GWS, which encompasses paying the technical assistant (~$40/mo) and eventually, for replacement parts. At present only some of the villages are able to pay the technical assistant, and thus this goal is a work in process. The device log is an important monthly working document identifying all problems related to the GWS, allowing quantification, review and appropriate responses, and key to the monitoring and evaluation process. EWfE has accomplished the development of a trained corporate staff competent in administrative operations, data collection and analysis of these, train the trainer programs for field staff and providing the basis to market the project within their local countries. Much of this comes down to the vital outcome of reducing diarrhea which changes everything for this population including no use of chemicals such as chlorine.

EWfE’s main goal over the next 3 years is to increase significantly, at an extremely low cost, the number of GWS installations in remote villages in Sub-Saharan Africa that have populations of 300-1000 people. EWfE will continue to seek support for its vital work as previously discussed, in partnerships with other NGOs, foundations and corporate sponsors, and will apply for research grants, compete for prizes and appeal to individual donors. Efforts will continue to demonstrate evidence of outcomes and to seek recognition and support from local and central governments in each country to enable further spread of the technology.