Laporan/Prosiding

A regional consultation was held in the WHO South-East Asia Regional Office from 5-9 November 2002 to formulate standard protocols for case-detection, surveillance and management of arsenicosis. There were 35 participants in the consultation representing Bangladesh, Bhutan, India, Indonesia, Myanmar, Nepal, and Thailand in addition to eight members of WHO secretariat. It covers all the related fields including toxicology, dermatology, internal medicine, oncology, epidemiology, nutrition and public health. The objectives of the consultation were; to review and endorse uniform case definition and surveillance algorithms for arsenicosis in the region, to review and formulate a uniform case management protocol for arsenicosis, and to formulate a protocol for validating these protocols. The agenda for the workshop is shown in Annex 2. Dr Caussy said that the goal of the workshop was to review the evidence on case-definition, management and surveillance and reach a consensus on a uniform regional protocol. The format consisted of country presentations, followed by group work. The groups further debated the chosen topics, reviewing all the available evidence, before reaching a consensus. The consensus of each group was further discussed and in the plenary session, they reached an overall consensus. The group also made recommendations for future actions. The members of the working groups are listed in Annex 3. Contents: 1. Introduction 2. Objectives 3. Inaugural Session 4. Presentations 4.1 Regional Overview 4.2 Country Presentations 4.3 Case Detection 4.4 Surveillance 4.5 Validation of Case Definition 4.6 Presentation and Adoption of Consensus Protocol 4.7 Case Management and Validation 4.8 Consensus Protocol 5. Recommendations 5.1 Recommendations of the Sub-committee on Case Definition 5.2 Recommendations of the Sub-committee on Case Management 5.3 Recommendations of the Sub-committee on Case Surveillance 5.4 Recommendations of the Sub-committee on Case Validation 5.5 General Recommendations of All Expert Committees 6. Conclusions Annexes: 1. List of Participants 2. Programme 3. Members of Working Groups

An intercountry workshop was held in Kolkata betwewn 24-26 March 2003 for the development of regional policy and guidelines on arsenic testing. There were 14 participants in the consultation representing Bangladesh, India, Myanmar, Nepal and Thailand. It covered all the related fields including toxicology, chemistry, biophysics, engineering, epidemiology, nutrition and public health.
 
The objectives of the workshop were as follows; to review the existing methods of arsenic testing, to develop strategies for laboratory testing of arsenic, to discuss regional policy and guidelines for arsenic testing in the countries of SEAR, and to develop a work plan for laboratory testing of arsenic.
 
The workshop was largely in the format of short presentations, followed by group activities and extensive interaction with the participants to reinforce the teaching aims and learning objectives. The group activities involved developing an outline of the generic SOP and the policy guidelines for arsenic testing.

Contents:

1. Introduction

2. Objectives and Format

3. Inaugural Session

4. Overview of Arsenic Testing in Countries of South-Esat Asia
4.1 Review of Regional Issues
4.2 Country Reports
4.3 Place of Standard Operating Procedure in Laboratory Testing
4.4 Overview of Regional Policy and Guidelines

5. Discussion on Testing Method and SOP Presentation and Adoption of Consensus Protocol

6. Recommendations

Annexes:
1. List of Participants
2. Programme
3. Proposed Contents of Generic SOP for Testing of Arsenic in Water, Environmental Sources and Biological Material in South-East Asia Region
 

Private sector participation is widely perceived to be the solution to the failure of many publicly owned and managed water utilities to operate efficiently and make the investments required to meet community needs. However, there are no guarantees that privatisation will actually yield the desired performence improvements. Simply converting a public sector monopoly into a private one provides no competitive incentives for the utility to operate efficiently, make appropriate investments or respond to consumer demands. Likewise, privatisation per se need do little to improve sector performance if governments are unwiling or unable to tackle such underlying problems as over-manning, uneconomic water pricing policies, financing the provision of public and merit goods, and restricting over-intrusive political intervention.
 
Given the characteristics of the water and sanitation sector it is inevitable that some form of continued public regulation of the private companies will be necessary. The regulatory burden can be reduced by adopting a competitive form of privatisation, choosing a more competitive sector structure and devising an appropriate regulatory regime. However, it has to be recognised that there will be a trade-off between making a venture attractive to private firms and introducing a notionally ’ideal’ regulatory system. Regulation in practice is a much about creating the conditions under which private firms can operate effectively and efficiently as it is about protecting specific customer and public interests.

Agenda 21 and  the Dublin Principles put the concept of water as an economic good on the global agenda, and they have received wide acceptance by the world’s water professionals. However, there is substansial confusion about the exact meaning of some of the articulated principles. In particular, it is not clear to many non-economists what is implied by the statement that water is an ”economic good“ or an ”economic and social good“. This paper addresses this lack of understanding by formulating the concept of water as an economic good and explaining, in practical terms, the economic tools that can be used to effect the environmentally, socially, and economically efficient use of water.
 
The potential role of economic tools in providing socially acceptable public decisions is not widely appreciated, particularly in many highly regulated situations. Furthermore, this paper suggests, contrary to the public perception, that with the improvement of the use of economic tools, the role for government regulation in managing water as an economic good is increased, not decreased.
 
The paper is divided into three sections following this introduction: Section I presents the general principles and methodologies for estimating costs and values in the water sector. In section II, some illustrative estimates of costs and values in urban, industrial, and agricultural sectors are presented based on available adta. Section III provides summary of results and conclusions.
 

This document has been written to support reform processes in water resources management and development, incipient or well underway, and to guide the development towards Integrated Water Resources Management (IWRM) as proposed in the Plan of Implementation of the World Summit for Sustainable Development (WSSD) in Johannesburg in 2002. Article 26 of this states that countries should ”Develop IWRM and water effiency plans by 2005, with support to developing countries....“. This guidance document discusses what these plans are all about under the overall umbrella of IWRM. Focus is on IWRM. The ”water efficiency plan“ is considered as an important component of IWRM, and hence as an integral part of the IWRM plan. As discussed in the document IWRM is a cyclic and long term ”process“. Hence, the ”IWRM plan“ can be seen as a milestone in this process, where the status of the process is documented.

Contents:

Preamble

Foreword

Preface

Introduction

IWRM Plans-Why

IWRM Plans-What

IWRM Plans-How

References

Annexes
 

Tujuan dari pedoman teknis ini adalah mengatur tatalaksana penilaian rumah dalam rangka peningkatan kondisi perumahan yang memenuhi persyaratan kesehatan, serta diperolehnya gambaran prosentase keluarga yang menghuni rumah sehat, potensi resiko penyakit akibat kondisi rumah yang tidak sehat, dan tersusunnya rekomendasi bagi pihak terkait dalam upaya perbaikan huniannya dalam menuju rumah sehat.
 
Sasaran pedoman teknis penilaian rumah sehat adalah pelaksana yang melakukan penilaian rumah di suatu wilayah, meliputi petugas sanitasi puskesmas, petugas sanitasi kabupaten/kota, serta petugas dari program lain atau sektor terkait yang menyelenggarakan penyehatan perumahan di tingkat kecamatan, kabupaten/ kota, propinsi dan pusat.

Daftar Isi:

Kata Pengantar
Daftar Isi
Daftar Singkatan

Pedoman Teknis Penilaian Rumah Sehat

I. Latar Belakang

II. Tujuan
A. Umum
B. Khusus

III. Sasaran

IV. Kriteria Rumah Sehat

V. Parameter Rumah yang Dinilai

VI. Cara Penilaian Rumah
A. Penilaian Rumah
B. Pemberian Nilai
C. Pembobotan

VII. Langkah-Langkah Penilaian
A. Persiapan
B. Pengolahan Data dan Analisa Data
C. Rekomendasi dan Tindak Lanjut

VIII. Penutup

Lampiran
 

Foreign direct investment is recognised to be important for economic development, in  terms of wealth creation, employment, skills development, and technology transfer. But there is an on-going debate about the extent to which these contributions translate into real benefits for people living in poverty.
 
In an attempt to evaluate the impacts of international business on people living in poverty, two organisations with very different aims and perspectives – Unilever (a major company operating in some of the poorest countries in the world) and Oxfam (an international development and humanitarian organisation) – collaborated on an ambitious research project. The research considered the impacts of Unilever Indonesia across the entire business value chain, from producers and suppliers, through the company’s core business operations, to its distributors, retailers, and consumers. This report presents the findings of the research. It is a contribution to the debates among the wider business community, governments, civil-society organisations, and academics who seek to understand how the wealth, employment, and products that a large compay creates could bring increased benefits to people living in poverty.

Contents:

Acronyms and Abbreviations
Foreword: Oxfam
Foreword: Unilever
Executive Summary

1. Introduction

2. The Impacts of Unilever Indonesia at the macro-economic level

3. The employment impacts of Unilever Indonesia

4. The value chain from supply to distribution

5. Low-income consumers in the marketplace

6. UI’s wider impact in the community

7. Conclusions

Notes

References and sources

Appendix 1: The Project team
Appendix 2: UI product list, 2003
 

Sodis, atau Solar Water Disinfection, merupakan teknologi sederhana yang memanfaatkan energi matahari untuk membunuh mikro-organisme patogen dalam air.
 
Buku ini berisi penjelasan tentang konsep teknologi, diseminasi, monitoring dan evaluasi sodis, serta contohcontoh media komunikasi sodis, berupa leaflet, komik, dan vcd.

Daftar Isi:

Latar Belakang

Bab 1. Konsep Teknologi Sodis
- Membunuh Bakteri dalam Air dengan Sinar Matahari
- Wadah Sodis
- Indikator yang Digunakan untuk Menguji Efisiensi dan Efektifitas Sodis
- Kelemahan Sodis
- Bagaimana Menggunakan Cara Sodis untuk Memenuhi Air Minum yang Sehat Bagi Keluarga
- Cara Melakukan Sodis
- Hal-Hal yang Paling Sering Ditanyakan

Bab 2. Diseminasi Sodis
- Sodis dan Gender
- Indikator-Indikator dalam Mengembangkan Strategi Diseminasi Sodis
- Strategi Diseminasi Sodis
- Kelebihan dan Kekurangan dalam Mendiseminasikan Sodis
- Pendekatan dan Metodologi Pelatihan Kader

Bab 3. Monitoring dan Evaluasi Sodis
- Monitoring Teknis
- Indikator dan Verifikasi Keberhasilan Program
- Permasalahan, Penyebab, dan Perbaikan yang Mungkin Dilakukan

Lampiran. Media Komunikasi Sodis
 

This manual has been prepared to serve as a reference resource for medical officers, health workers and programme officers to use for clinical diagnosis of arsenicosis caused by chronic arsenic poisoning from drinking water or contaminated food due to coal burning. It also is intended for use in the training of medical professionals and health workers.
 
This manual is the first publication on clinical diagnosis of skin lesions of arsenicosis. Medical professionals have yet to establish a clear case definition of arsenicosis. However, a group of arsenicosis experts in the People’s Republic of China developed guidelines for clinical identification based on their decades of field experiences dealing with chronic arsenic poisoning. China’s Ministry of Health recently approved those guidelines.
 
Adopting the Chinese classification, this manual presents symptoms of skin lesions of arsenicosis, along with photos to illustrate its stage-by stage manifestation, that are based on cases in affected areas in China. Some variation of symptoms between areas does occur. For instance, ”black foot disease“ is associated with the consumption of drinking water containing high levels of arsenic and humic substances having fluorescent matter but was found only in Taiwan province in the 1950s. So far, it has not been identified in any other affected area in China (This manual does not include symptoms of black foot disease). Generally, however, skin lesions of arsenicosis in the forms of hyperkeratosis, hyper-pigmentation and hypo-pigmentation commonly are diagnosed in patients suffering from chronic arsenic poisoning due to the consumption of water, food or inhaling air containing high levels of arsenic. It is these symptoms taht are the focus of this manual.
 
For readers’ convenience, this manual has been published in separate English and Chinese versions.

Contents:

Acknowledgments
Preface

I. Endemic Chronic Arsenic Poisoning in China
1. Overview of the situation in Asia
2. Background of endemic chronic arsenic poisoning in China
3. Current situation of endemic chronic arsenic poisoning in China
4. Nature of endemic chronic arsenic pisoning in China
5. Factors effecting arsenicosis manifestation in China
6. Clinical and sub-clinical symptoms of arsenicosis patients in China
7. Long-term chronic arsenic toxicity and endemic cancer in China
8. China’s approach for prevention of endemic chronic arsenic poisoning

II. Key points of teh Chinese Guidelines for Clinical Diagnosis of Arsenicosis
1. Definition
2. Diagnostic criteria
3. Skin lesions as the major diagnosis index
4. Dermatological metamorphosis classification
5. Classification of clinical diagnosis

III. Photo Illustrations of Skin Lesions of Arsenicosis Manifestation
1. Hyperkeratosis on the palms (symptoms manifested from mild to advanced cases in adults)
2. Hyperkeratosis on the soles (symptoms manifested from mild to advanced cases in adults)
3. Coetaneous hyper-pigmentation and hypo-pigmentation on the trunk (symptoms manifested from mild to advanced cases in adults)
4. Bowen’s disease and skin cancer
 

Natural arsenic pollution of groundwater and surface water affects more than 140 million people in at least 70 countries worldwide. In half the countries where arsenic pollution is now known, it was discovered within the last ten years, and it is almost certain that it will be found in many more. The objective of this study is to predict the other countries and regions in which there is a significant risk of finding arsenic pollution.
 
By examining known arsenic occurences, their geochemistry, and their climatic and geological associations, it has proved possible to develop a set of predictive rules that have been embodied in a GIS model. This model not only predicts the locations where there is a risk that groundwater is polluted by arsenic, it also estimates the population of the ’at risk’ regions, and hence provides a basis for predicting the size of the population which may be exposed to drinking arsenic above the WHO guideline value and/or local standards. The GIS model does not predict all known forms of natural arsenic pollution, but based on known occurrences, is expected to predict more than 90% of them.
 
The GIS model has been applied to the whole world, and this report provides maps of the at risk areas and listings of the at-risk population in each country. The model successfully predicts the vast majority of the major known cases of pollution. The model predicts a risk of arsenic pollution in 54 countries where pollution is known to occur, and also in a further 53 countries where it is not known. Nine countries, with large at-risk populations but no reported cases of pollution, have been selected for more detailed mapping. These countries were chosen to represent a range of conditions and include four in Asia (Indonesia, the Philippines, Iraq, and Uzbekistan), two in South America (Colombia and Venezuela) and three in Africa (Ethiopia, Sudan and Marocco).
 
Where a risk of arsenic pollution is predicted, relevant courses of action are recommended. In countries where arsenic is a familiar problem, it may be sufficient to provide guidance for additional surveys. Where arsenic pollution is predicted but not known, a second tier of desk study is recommended to evaluate the model predictions in the light of national data sets and, provisionally, to identify areas, personnel and testing protocols for field surveys.

Contents:

1. Introduction
1.1 Background
1.2 Scope and Purpose
1.3 Acknowledgments

2. Scientific Basis of the Model
2.1 Geochemical Mobilisation Mechanisms
2.2 Geological and Climatic Setting
2.3 Population: Exposed and At-Risk
2.4 Prediction Principles

3. Formulation of Predictive Models in Geographical Information Systems
3.1 Arsenic Risk in Alluvial Aquifers
3.2 Sulphide-Oxidation in Bedrock Aquifers
3.3 Glacial Aquifers

4. Discussion of Model Results
4.1 Preamble
4.2 Europe, North America and Australasia
4.3 Asia
4.4 South and Central America
4.5 Africa
4.6 The Sulphide-Oxidation Model
4.7 Secondary Data Processing
4.8 Summary and Screening by Country

5. How to Interpret and Use Models Results
5.1 Initial Enquiries
5.2 If Reductive Dissolution is the Predicted Mechanism
5.3 If Alkali-Desorption is the Predicted Mechanism
5.4 Surveys of Arsenic in Well Waters

6. Predictions of Arsenic Risk by Region
6.1 Europe, North America and Australasia
6.2 Asia
6.3 South and Central America
6.4 Africa

7. Conclusions and Recommendations