Managing microbial risks of drinking water and sanitation to prevent waterborne infectious diseases

Unsafe drinking water and sanitation are major causes for the spread of waterborne diseases. Drinking water supply and sanitation services face threats, such as aging infrastructure, urbanization and climate changes, which may affect the transmission of microbial hazards. Risk management is crucial to identify and to manage risks in a structured and continuous way. Risk management includes risk assessment and water quality monitoring. In risk assessment, microbial hazards can be identified and risks can be estimated. To reduce the risks control measures can be introduced. Monitoring the quality of drinking water and wastewater are key elements to ensure drinking water and sanitation safety by providing (early) signals of hazards for remediate actions to reduce the risks. This thesis will focus on risk management for drinking water supply and sanitation systems to prevent waterborne infectious diseases in different countries: The Netherlands, Ethiopia, Serbia and Mozambique. The main objective is to better integrate water quality monitoring and risk assessment into risk management approaches. Another objective is to integrate risk management approaches for drinking water supply and/or sanitation services in order to reduce waterborne infectious diseases. The main conclusion from this thesis is that both risk assessment and water quality monitoring contribute to risk prevention. Therefore both approaches should be well embedded in risk management. Risk management needs to be reviewed regularly to be up-to-date. In this way, health risks related to drinking water and sanitation now and in the future are minimized. It is possible to integrate risk management methods. In this thesis, risk management for drinking water and sanitation services were integrated into one approach. This can be extended by integrating risk management for other water applications in order to use the water correctly and efficiently.