CEPIS | introduction | mission | goal | purpose | expected results | general activities | matrix of action | implementation strategies | rationale

CEPIS

The Pan American Center for Sanitary Engineering and Environmental Sciences, CEPIS, is the specialized center for environmental technology of the Pan American Health Organization (PAHO), Regional Office for the Americas of the World Health Organization (WHO).
The Center was established in 1968 and is located in Lima, Peru. The Peruvian Government provided CEPIS premises and finances some of its operating costs. CEPIS is part of PAHO's Division of Health and Environment and develops its activities with the support of PAHO/WHO Country Representative Offices
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1.- INTRODUCTION

As an intergovernmental technical cooperation body, the Pan American Sanitary Bureau maintains close relations with the ministries of health of the Member States as primary partners and with a broad range of sectors and institutions to collaborate in the achievement of national and regional sanitary goals. Taking into account the role and importance of the ministries of health in managing environmental health, the strengthening of capabilities and competences of the same is fundamental, particularly of the environmental health units at the different levels: national, regional, and local. They play an important role in the promotion, regulation, monitoring, and surveillance of environmental health issues helping to achieve service coverage with quality, equity, and search for sustainable human development.

2.- MISSION

3.- G0AL

4. PURPOSE

Strengthen national capabilities in the countries of the Region to accomplish essential public health functions in basic environmental sanitation

5.- EXPECTED RESULTS

• Strengthen sanitary regulation
• Promote the generation and use of knowledge
• Promote interventions  

6.- AGENERAL ACTIVITIES

Strengthen sanitary regulation

a) Advise on the definition and implementation of policies and standards
b) Promote the adoption of surveillance systems of basic environmental sanitation services
c) Strengthen the capacity of laboratories to improve their analytical quality.

Promote the generation and use of knowledge

a) Promote and support the development of applied research on technologies

b) Promote and participate in networks of information and specialized collaboration

c) Develop with the countries analyses of health and basic environmental sanitation

d) Support the exchange of information, taking advantage of the potential of modern communication and information technologies

e) Disseminate technological and management models in environmental basic sanitation.

a) Support, advise, and promote programs oriented to the extension of coverage and improvement of service quality

b) Promote citizen mobilization through timely information access and hygiene education programs to foster responsible participation in the search of sustainable development

c) Advise on programs for vulnerability mitigation to face natural disasters. Participate in mitigation actions and during emergencies

7.- MATRIX OF ACTION

A holistic approach will be applied in CEPIS/PAHO technical cooperation, which envisages the development of tools to strengthen the regulatory framework (legislation and technical standards); sanitary surveillance; health promotion (health education, community participation, social mobilization); institutional capacity building; analytical quality assurance of laboratories; and information. The attached table has taken into account essential public health functions in the Americas, understanding that they represent a set of actions that should be carried out to achieve the central objective: health population improvement. These essential public health functions are:

• Monitoring, evaluation, and analysis of the health situation
• Public health monitoring, research, and control of public health risks and damages
• Health promotion
• Citizen participation in health issues
• Policy development and institutional capacity building for public health planning and management
• Strengthening of institutional capacity for regulation and control with regard to public health
• Evaluation and promotion of equitable access to health services
• Human resources development and training in public health
• Quality guarantee and improvement of individual and collective health services
• Public health research
• Reduction of the impact of emergencies and disasters on health.

In this context, the Resolution CD43.R15 of the 43rd Directing Council of the Pan American Health Organization on Health, Drinking Water and Sanitation in Sustainable Human Development, proposes essential functions for the ministries of health, which have been taken into account in the definition of the technical cooperation scope: a) surveillance, b) regulation, c) coordination, d) human resources development, e) education and hygiene, and f) prevention and preparedness for emergencies and disasters.

The Matrix of Action details CEPIS/PAHO specific subjects, cross-
sectional topics, and technical cooperation tools in basic environmental sanitation.

Technical Cooperation in Basic Environmental Sanitation
CEPIS/PAHO

For the specific subjects made up of: a) drinking water; b) wastewater and excreta disposal, and c) solid wastes, their respective scopes have been defined as follows:

• Drinking water, including sources of drinking water, treatment, distribution, and use
• Wastewater and excreta disposal, including collection, treatment, utilization, sanitary excreta disposal, and final disposal in the environment and water bodies
• Solid wastes, including integrated management of dangerous and municipal solid wastes (hospital and industrial), storage, collection, transportation, treatment, and final disposal.
  

7.2 Cross-sectional topics

Cross-sectional topics to the specific topics consist of: a) information; b) analytical quality assurance of laboratories; c) health education and social participation; d) epidemiological evidence; and e) prevention and preparedness for emergencies and disasters.

• Information, Will have as a purpose the availability of up-to-date information, recorded by the institutions of the sector that work actively in REPIDISCA national networks. The extensive use of this wealth of information is expected through the BVSA or other means by the greatest number of interested parties, for which software and methodological manuals compatible with other PAHO BVS have been prepared.

• Analytical quality assurance, Will help improve the capability and analytical quality of environmental laboratories to optimize the comparability of environmental measurements in the Region. The purpose is to obtain reliable data for decision-making contributing to the accreditation process of laboratories with public health mandates of control and environmental surveillance

• Health education and social participation, Will strengthen the processes of governance, decentralization, and citizenship in the countries of the Region for the adequate management of basic environmental sanitation. It includes social participation, understood as the exercise of a responsible duty toward the achievement of efficient and sustainable services that will ensure better health conditions.

• Epidemiological evidence, Will apply the epidemiological methodology in the assessment of human health impact associated with basic environmental sanitation.

• Prevention and preparedness for emergencies and disasters, Will support institutions of the water and sanitation sector to strengthen their response capability so that they can ensure the continuation of basic environmental sanitation services during emergencies and disasters. As well, it will support the formulation of contingency plans by the health sector.

7.3 Tools

The tools to be managed by CEPIS/PAHO will be: a) knowledge networks; b) appropriate technologies; c) management tools; and d) strategic analyses

• Knowledge networks, Its mission is to identify, record, process and disseminate information, facilitating the process of human resources development through distance education or certified self-instruction courses, complementing them with discussion lists, forums, bulletins, and video conferences. Its tools are the networks of institutions and professionals, strategic partnerships, the virtual library, and specialized publications.

• Appropriate technologies, Analyzes the link between the physical component of the same with the information and organization required for its use, as well as its relation with the ability to pay and cultural conditions of the beneficiary community. The vision is holistic and the final goal is to achieve sustainable interventions. Its tools are intervention methodologies, applied research, and evaluation of projects and technologies related to drinking water, wastewater, excreta disposal, and management of solid waste.

• Management tools,: It includes scientific material as guides, manuals, standards, regulations, systematization of experiences (learned lessons), databases, and regional plans to achieve the improvement of the capacity of institutions and professionals involved in basic sanitation. Its tools are the guides, software, intervention methodologies, and procedures for design, operation, maintenance, monitoring and surveillance.

• Strategic analyses, Evaluates through indicators the current situation of the countries and existing policies in each of them with regard to the emerging and chronic problems derived from deficiencies in local basic sanitation, It will also assess the impact of CEPIS/PAHO programs and its operation plans. Its tools are the national or regional analyses and analytical reports in drinking water, wastewater, excreta disposal, and management of solid waste; systematized reports (inventories, studies of case), and the Information System in Environmental Sanitation (SISAM).

8. IMPLEMENTATION STRATEGIES

To fulfill its responsibilities, CEPIS/PAHO will adopt an operational matrix structure in the areas of water, wastewater, excreta, and solid wastes, including cross-sectional topics and the use of the above mentioned cooperation instruments.

As an intergovernmental technical cooperation body, CEPIS maintains close relations with the countries of the Region. Being the ministries of health the primary partners of PAHO, an important part of the technical cooperation will support this sector. As well, relations, partnerships, and joint ventures will be forged with other sectors and bodies working in basic environmental sanitation to collaborate in the achievement of national, regional, and global sanitary goals.

The regional situation, international forums, and especially the World Summit on Sustainable Development point out the urgent need of multidisciplinary and multisectoral work with cooperative agencies to respond the resulting demands. The progressive complexity of modern problems and the need for strengthening sectoral organizations will be taken into account. Consequently, an open-minded attitude, sharing of experiences, and development of common interest projects and alliances are necessary.

CEPIS for many years has given special importance to alliances with several agencies, including sectoral NGOs and collaborating and associated centers. The strengthening of the International Networks of Ecoclubs and the Primary Environmental Care strategy are proposed.

At PAHO level, coordination is made with the Area of Sustainable Development and Environmental Health (SDE), as well as with its three units and a center: Unit of Local and Urban Development (LU); Unit of Risk Assessment and Management (AR); Unit of Healthy Settings (HS), and the Institute of Nutrition of Central America and Panama (INCAP) to respond the requirements of technical cooperation of the countries in harmony with PAHO/WHO Representative Offices. CEPIS will develop initiatives to accelerate sanitary improvements in Bolivia, Haiti, Honduras, Guyana, and Nicaragua.

The present document is complemented with an analysis of resources and a manual on organization and functions will be prepared.

9.-RATIONALE

9.1 Situation– population, health, services

The Region has experienced a considerable population growth, which doubled in the second half of the 20th Century; from less than 400 million inhabitants in 1950 it amounted to more than 800 million inhabitants in the year 2000.

More than 10% of every year of life adjusted by disability (DAYs “Disability Adjusted Life Years”) missed in Latin America are due directly to environmental and occupational risk factors, corresponding 5.5% to water supply and sanitation; the remaining correspond to urban air pollution, chemical substances, agricultural wastes, and indoor air pollution. These global figures mask profound differences between countries and within cities of the same country.

Infant mortality has declined considerably in recent years, although it continues to be unacceptably high for many populations. In the Region of the Americas annually die 77,600 children under 5 years old owing to diarrheal diseases. Starting in the nineties, cholera has recurred affecting more than 1.2 million people and causing 12,500 deaths.

Considering the consequences for health and sustainable development, it is imperative to protect natural water resources. It is not sufficient to provide enough quantity of water, but ensure water quality for different uses, e.g., drinking water, irrigation, and recreation using practical and economical means. This is the direct relation between water resource protection and basic environmental sanitation. The quality of the water source in accordance with a specific use is the basic parameter to determine the level of wastewater treatment. In LAC, however, municipal wastewater, industrial effluents, and agricultural runoff are discharged into water bodies without adequate treatment or without any treatment at all. Groundwater pollution is in general irreversible economically. Besides, there is the problem of quantity reduction in suitable sources for human consumption due to contamination, over exploitation, and competition.

According to data and information based on the Assessment of Drinking Water and Sanitation 2000 in the Americas, currently with a population of 497,329 million people, 84,59% of the population has drinking water services, either with connection or easy access to a public standpipe. This means that 76,540 million people (15,41%) do not have access to some form of safe drinking water. There is the added fact that around 53,908 million people (10,86%) get water through systems defined as "easy access" that represent a significant health risk, mainly for the most vulnerable populations, as children and the elderly.

In addition, it is estimated that in Latin America and the Caribbean more than 219 million people that constitute 60% of the population served through house connections of drinking water are served by systems with intermittent operation. Considering that control, health surveillance, and quality certification for these systems are almost nonexistent, they represent a latent danger for the users. It is observed that the population served by inefficient systems in terms of continuity frequently use health care services owing to diarrhea and other water-borne diseases.

A study conducted by CEPIS/PAHO in 1994 estimated that only 59% of the population of Latin America and the Caribbean received disinfected water regularly. In 1995, 23 countries of this Region notified that the majority of the people living in urban communities received water in accordance with WHO guidelines for drinking water quality. However, the same does not occur in rural areas.

In Latin America and the Caribbean only 241,311 million people, 48,61% of the population, are connected to conventional sanitary sewerage systems and 151,921 million people, 30,60% of the population, are served by on site sanitation systems, such as latrines, septic tanks, among others.

It is estimated that 103,237 million people, 20,79% of the population of Latin America and the Caribbean, do not have wastewater and excreta disposal systems, of which 37,054 millions, 10,15%, correspond to urban areas and 66,183 million, 50,41%, to rural areas. Lack of wastewater treatment continues to be one of the most serious sanitary problems in the Region, mainly in the Caribbean. The Assessment 2000 indicates that only 13.7% of the wastewater collected by the few existing sewerage systems is treated.

As a consequence of land disposal of wastewater, there are several sites where the content of nitrogen compounds in groundwater has increased to very high values. Currently, the increase of toxic substances in industrial wastes and the general use of toxic agricultural chemicals are widespread.

At the regional level, there are several critical issues still not resolved. Some of them are: insufficient political support of the governments to sectoral institutions, lack of sanitary awareness in the population, urgent need to change methodologies and criteria to finance wastewater treatment facilities, inadequate environmental policies, institutional deficiencies, and the need of technical standards for waste disposal and treatment.

The Region generates daily more than 360,000 tons of household residues, with an ever-decreasing content of biodegradable wastes and more polluting residues (insecticides, paints, inks, disinfectants, batteries, etc.). The collection coverage in the majority of medium cities ranges between 50 and 70%, while in many peri urban areas of large and small cities, as well as in rural towns, collection services are even more deficient or in many cases they do not exist.

It is estimated that more than 70% of the waste are disposed of in open dumps, in watercourses, in public thoroughfares or are used as swine food. Less than 30% of the waste goes to sanitary or controlled landfills.

In the majority of the cities hazardous wastes (from hospitals and industries) are handled jointly with municipal waste and its final disposal is done in open dumps (3,600 t/d of hospital wastes are estimated, of which more than 600 tons are dangerous).

More than 100,000 families are dedicated to informal waste recycling in open dumps. They work in unhealthful conditions and represent more than 300 thousand people, of which nearly 30% are children.

9.2 Situation– Institutional aspects.

The organization and operation of the sector has not managed to ensure adequate access to water and sanitation services for nearly a fourth of the population in the Region. Health protection goes beyond safeguarding water quality for human consumption. Distributing water of good quality, with continuity and at accessible prices requires a well organized, regulated and administered sector, and high-level human resources. Water quality standards and surveillance laboratories cannot contribute significantly to service quality improvement if water utilities do not guarantee good operation and maintenance of their installations and if limitations of coverage and inequities are not solved.

To overcome these limitations, actions are required aimed at strengthening the capacity and performance of the institutions according to current trends in the Region, including decentralization and participation of the private sector, nonprofit entities, and grassroots organizations.

The role of the ministries of health. Taking into account the importance of water and sanitation services, health authorities play an important role in their promotion, surveillance, and regulation. As pointed out in the World Health Organization report to a special session of the United Nations General Assembly, June 1997, “the 21st century requires a new health system that favors alliances based in the health of the population foreseeing events rather than reacting to them.”

Distinguishing responsibilities of the health authority and the specific role of responsible sectoral institutions, the ministries of health should monitor and advocate basic environmental sanitation. The participation of the ministries of health in this management includes objectives associated with public health, universal coverage of services, abatement of inequities, and search for sustainable human development. It includes the essential functions discussed in (7).

9.3 Comprehensive approach and priorities

L The effective management of public health requires a vision of continuum for basic environmental sanitation. This vision of continuum includes: a) the environment, b) services and systems, and c) the population. The environment includes water sources for drinking and for recreation. Services and systems include municipal water supply and sanitation services, regulatory frameworks, and water quality surveillance systems in charge of the ministries of health, among others. The population includes the families of urban, rural, and urban fringe areas that can be affected by gastrointestinal diseases produced by poor basic sanitation services and inappropriate hygiene practices.

Human development is the process of offering options to the population through the expansion of essential capabilities: health, knowledge, resources, and fundamental rights. Access equity to these capabilities is a central element for sustainable development. Poverty is basically the privation or reduction of these capabilities. It has been demonstrated that basic environmental sanitation is instrumental for the construction of these essential capabilities. Increasingly, the management of basic environmental sanitation is associated with the struggle against poverty (it includes MDG).

It is recognized that there are countries, regions, and areas within the countries that lag behind sanitary development. These areas coincide with zones of extreme poverty and include rural and peri urban areas, as well as ethnic communities and disaster prone areas. Special attention will be given to countries with low level of sanitary conditions. Generally, these are heavily indebted countries, whose payment of the foreign debt limits the mobilization of resources to improve the social sector. As well, maternal and children mortality rates are the higher of the Region and are among the higher of the world. These countries are Bolivia, Haiti, Honduras, Guyana, and Nicaragua.

9.4 Mandates and regional commitments

a) PAHO - WHO

The work of the Organization is framed under the Health for All goal and WHO work programs. The Office has regional mandates of different origin, mainly the resolutions of the Governing Bodies of PAHO. We point out the Strategic Plan of the Pan American Sanitary Bureau for the period 2003-2007; Resolution CD43.R15, Document CD43/10 related to Health Water and Sanitation in Sustainable Development, and CSP26/17, R16 related to the Hemispheric Meeting of Ministers of Health and Environment held in Ottawa in 2002. Finally, the Directive HQ/FO-03-02, which describes the functions of the different Offices at the Central level, Areas, Units and Centers of the Pan American Health Organization indicating the functions of the Area of Sustainable Development and Environmental Health (SDE). See Annex 1.

b) Global

Mandates also emanate from international meetings in which WHO or the Office assumes a concrete responsibility. The international mandates include:

• The eleven WHO priorities for the period 2002-2005
• Summit of Johannesburg (2002)
• The goals of the Declaration of the Millennium of the United Nations (2000)
• Agreements of world conferences that addressed issues of population and health (El Cairo, 1990), social development (Copenhagen, 1995), and environment and sustainable development (Rio de Janeiro, 1992).

c) Regional

Mandates of regional meetings in which the Office assumes a specific responsibility include:

• Commitments contracted at the Summits of the Americas held in Miami (1994), Santiago (1998), and Québec (2001)
• Commitments contracted at the Ibero-American Summit of Panama (2000
• Meeting of Ministers of Health and Environment of the Americas (Ottawa 2002).

An examination of this list indicates a series of general goals with which the Region is committed: a) reduction of extreme poverty; b) equity in development; c) human rights and democracy; d) sustainable development; and e) protection of vulnerable groups.

Annex 1

PAN AMERICAN HEALTH ORGANIZATION

Directive No.: HQ/FO-03-02 1 March 2003
Distribution: To All Staff
Subject: New Organizational Structure and Functions

Objective

On 1 March 2003 the Pan American Sanitary Bureau (PASB) underwent significant modifications in its organizational structure:

Functional Descriptions

3. OFFICE OF THE ASSISTANT DIRECTOR (AD)

The Office of the Assistant Director includes four Areas: Disease Prevention and Control (DCP), Sustainable Development and Environmental Health (SDE), Family and Community Health (FCH), and Technology and Health Services Delivery (THS).

3.3. Sustainable Development and Environmental Health (SDE)

• Designs and implements technical cooperation to address the relationship between health conditions and the physical and psychosocial environment for attaining human security.
• Supports countries in the design and implementation of intersectoral approaches focusing on the relationship between health and sustainable development.

The Area of Sustainable Development and Environmental Health is comprised of five units: Local and Urban Development (LU); Risk Assessment and Management (RA); Healthy Settings (HS); Pan American Center for Sanitary Engineering and Environmental Science (CEPIS), and the Institute of Nutrition of Central America and Panama (INCAP).

• Local and Urban Development Unit (SDE/LU)
  Promotes health as an essential element to assess and drive the sustainability of the development of local communities and cities (including metropolis).
• Develops participative methodologies to analyze, identify, and promote effective health interventions that positively affect the determinants of health in these environments.
• Supports country efforts in the development of affordable and sustainable water and sanitation services.

Risk Assessment and Management Unit (SDE/RA)

• Strengthens environmental health institutions to perform health surveillance, adopt adequate regulations and promote public health interventions that will help prevent health hazards.
• Promotes the use of risk assessment and risk management concepts to guide technical cooperation activities.
• Develops institutional capacity for the promotion of risk management, including tobacco use prevention, providing the necessary elements to influence other sectors responsible for reducing risks that can damage health.

Healthy Setting Unit (SDE/HS)

• Promotes the design and implementation of health promotion strategies as a collective intervention to achieve healthy settings.
• Provides technical cooperation that embodies the application of methodologies and models of healthy spaces such as healthy municipalities, healthy communities, healthy workplaces, and healthy schools with a view to prevent and minimize risks, including intentional and unintentional injuries.

Pan American Center for Sanitary Engineering and Environmental Sciences (CEPIS)

• Provides regional technical cooperation on basic sanitation with a view to strengthen national institutions and build capacity in the management of health aspects related to water supply for human consumption, sanitary excreta and solid waste disposal, with an emphasis on PAHO priority countries and the most susceptible populations.
• Leads collaborative efforts and establishes networks among collaborating partners and relevant stakeholders, centering actions on the identification, development, adaptation and dissemination of concepts, methods, tools and experiences applicable to the promotion of studies and technologies that can ensure the best possible basic sanitation conditions.

Institute of Nutrition of Central America and Panama (INCAP)

• Strengthens national capacities of its member countries to implement the food and nutrition security initiative as an essential strategy for human sustainable development.
• Promotes the local integrated community development approach and helps develop and disseminate knowledge, methods, technologies and models for achieving an optimal food and nutritional situation.