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Safe Water System Manual




In 2000, just 10 years after the end of the Water and Sanitation Decade, the lack of access to safe water remains a problem for more than a billion people in the developing world. Annually, 2 to 3 million children less than 5 years old die of diarrheal diseases, a large proportion of which are acquired through exposure to contaminated water. In addition, after 39 years, the 7th pandemic of cholera continues unabated, claiming the lives of a high percentage of children and adults who acquire the disease. There are a number of reasons for the persistence of these problems, in spite of the investment of billions of dollars in safe water by donor agencies and governments. Population shifts from rural to urban areas have stressed existing water and sanitary infrastructure and exceeded the capacity of most countries to keep up with demand. Large population dislocations caused by armed conflict and natural disasters have created enormous logistical problems in providing water and sanitation services, as have dispersed populations and poor transportation infrastructure in many rural areas. While larger scale projects, such as the construction of deep wells or piped water systems, remain an important objective of many development agencies, a shortage of time and resources will leave hundreds of millions of people without access to safe water into the foreseeable future.

The Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization developed the household-level water quality intervention described in Safe Water Systems for the Developing World: A Handbook for Implementing Household-Based Water Treatment and Safe Storage Projects to help bridge the enormous gap in developing countries between populations served by existing water projects and those most in need. This handbook, produced by the CARE/CDC Health Initiative, is a valuable tool for providing inexpensive and feasible appropriate-technology alternatives in situations where resources are not available for improvements in infrastructure.

While we fully support efforts to build the infrastructure necessary to create a healthier living environment for people in developing countries, we also recognize that such efforts will not meet the enormous global need in the near term. Because of that, CARE and CDC have joined together under the CARE/CDC Health Initiative to conduct implementation projects in Kenya and Madagascar that build on the successes of projects in other countries. We have designed this manual for program managers and technical personnel in other parts of the world who may find this approach helpful in implementing their own projects.

We hope that you find Safe Water Systems helpful and invite your comments and suggestions ( on making it more useful.


Peter D. Bell
President and CEO Director
Jeffrey P. Koplan, M.D., M.P.H.
Centers for Disease Control and Prevention



The following individuals provided valuable assistance in the form of original material or critical review:

Centers for Disease Control and Prevention
Eric Mintz, MD, MPH
Steve Luby, MD, MPH
Robert Tauxe, MD, MPH
Jeremy Sobel, MD, MPH
Patricia Riley, CNM, MPH

Peter Lochery
Luke Nkinsi, MD, MPH

Gangarosa International Health Foundation
Eugene Gangarosa, MD

Pan American Health Organization
Dra. Caroline Chang de Rodriguez, (Ecuador)
Ing. Ricardo Rojas (Centro Panamericana de Ingenieria Sanitaria, Peru)

Population Services International
Janet Livingstone

Besecker Gray Consulting
Samantha Gray

Medical University of South Carolina
Angelica Thevos, MSW, PhD

The Swiss Federal Institute for Environmental Science and Technology
Department of Water and Sanitation in Developing Countries
Martin Wegelin
Bruno Gremion



Centers for Disease Control and Prevention
National Center for Infectious Diseases
Division of Bacterial and Mycotic Diseases
Foodborne and Diarrheal Diseases Branch


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