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. 2015 Oct 27;12(10):13602-23.
doi: 10.3390/ijerph121013602.

Evaluation of Membrane Ultrafiltration and Residual Chlorination as a Decentralized Water Treatment Strategy for Ten Rural Healthcare Facilities in Rwanda

Alexandra Huttinger  1 , Robert Dreibelbis  2 , Kristin Roha  3 , Fidel Ngabo  4 , Felix Kayigamba  5 , Leodomir Mfura  6 , Christine Moe  7
Affiliations

Evaluation of Membrane Ultrafiltration and Residual Chlorination as a Decentralized Water Treatment Strategy for Ten Rural Healthcare Facilities in Rwanda

Alexandra Huttinger et al. Int J Environ Res Public Health. .

Abstract

There is a critical need for safe water in healthcare facilities (HCF) in low-income countries. HCF rely on water supplies that may require additional on-site treatment, and need sustainable technologies that can deliver sufficient quantities of water. Water treatment systems (WTS) that utilize ultrafiltration membranes for water treatment can be a useful technology in low-income countries, but studies have not systematically examined the feasibility of this technology in low-income settings. We monitored 22 months of operation of 10 WTS, including pre-filtration, membrane ultrafiltration, and chlorine residual disinfection that were donated to and operated by rural HCF in Rwanda. The systems were fully operational for 74% of the observation period. The most frequent reasons for interruption were water shortage (8%) and failure of the chlorination mechanism (7%). When systems were operational, 98% of water samples collected from the HCF taps met World Health Organization (WHO) guidelines for microbiological water quality. Water quality deteriorated during treatment interruptions and when water was stored in containers. Sustained performance of the systems depended primarily on organizational factors: the ability of the HCF technician to perform routine servicing and repairs, and environmental factors: water and power availability and procurement of materials, including chlorine and replacement parts in Rwanda.

Keywords: chlorination; implementation; low-income countries; maintenance; membrane water treatment; operation; quality; sustainability; ultrafiltration.

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Figures

Figure 1
Figure 1
Event log timeline of water treatment system service interruptions and causes at ten health centers in rural Rwanda, March 2012–December 2014.
Figure 2
Figure 2
Functionality of water treatment systems at ten health centers in rural Rwanda, March 2012–December 2014.
Figure 3
Figure 3
Determinants of water treatment system performance derived from sustainable health services delivery framework *. (* Adapted from Sarriot et al. 2004 [34] and Schreier et al. 2011 [32].)
See this image and copyright information in PMC

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