STRATEGIES FOR THE TRANSFER OF APPROPRIATE TECHNOLOGY TO DEVELOPING COUNTRIES: THE IMPLEMENTATION AND DEVELOPMENT OF ENVIRONMENTAL HEALTH PROGRAMS IN TUNISIA

This dissertation focuses on Project HOPE, an American medical aid agency, and its work in Tunisia. More specifically this is a study of the implementation strategies of those HOPE sponsored projects and programs designed to solve the problems of high morbidity and infant mortality rates due to environmentally related diarrheal and enteric diseases. Several environmental health programs and projects developed in cooperation with Tunisian counterparts are described and analyzed. These include (1) a paramedical manpower training program; (2) a national hospital sanitation and infection control program; (3) a community sewage disposal project; (4) a well reconstruction project; and (5) a solid-waste disposal project for a hospital.^ After independence, Tunisia, like many developing countries, encountered several difficulties which hindered progress toward solving basic environmental health problems and prompted a request for aid. This study discusses the need for all who work in development programs to recognize and assess those difficulties or constraints which affect the program planning process, including those latent cultural and political constraints which not only exist within the host country but within the aid agency as well. For example, failure to recognize cultural differences may adversely affect the attitudes of the host staff towards their work and towards the aid agency and its task. These factors, therefore, play a significant role in influencing program development decisions and must be taken into account in order to maximize the probability of successful outcomes.^ In 1969 Project HOPE was asked by the Tunisian government to assist the Ministry of Health in solving its health manpower problems. HOPE responded with several programs, one of which concerned the training of public health nurses, sanitary technicians, and aids at Tunisia's school of public health in Nabeul. The outcome of that program as well as the strategies used in its development are analyzed. Also, certain questions are addressed such as, what should the indicators of success be, and when is the time right to phase out?^ Another HOPE program analyzed involved hospital sanitation and infection control. Certain generic aspects of basic hospital sanitation procedures were documented and presented in the form of a process model which was later used as a "microplan" in setting up similar programs in other Tunisian hospitals. In this study the details of the "microplan" are discussed. The development of a nation-wide program without any further need of external assistance illustrated the success of HOPE's implementation strategies.^ Finally, although it is known that the high incidence of enteric disease in developing countries is due to poor environmental sanitation and poor hygiene practices, efforts by aid agencies to correct these conditions have often resulted in failure. Project HOPE's strategy was to maximize limited resources by using a systems approach to program development and by becoming actively involved in the design and implementation of environmental health projects utilizing "appropriate" technology. Three innovative projects and their implementation strategies (including technical specifications) are described.^ It is advocated that if aid agencies are to make any progress in helping developing countries basic sanitation problems, they must take an interdisciplinary approach to progrm development and play an active role in helping counterparts seek and identify appropriate technologies which are socially and economically acceptable. ^

Onsite Wastewater Model Performance Code Implementation Plan

As the population of Colorado continues to grow, the impacts from individual sewage disposal systems, or onsite wastewater systems (OWS), are becoming more apparent. Increased use of OWS impacts not only water quality but land use and development as well. These impacts have led to the need for a new generation of wastewater regulations in the state, a transition from the historic prescriptive requirements to a more progressive, performance-based system. A performance-based system will allow smarter growth, improved water quality, and cost savings for both the regulatory agencies and the OWS industry in Colorado. This project outlines the challenges and essential elements required to make this transition, and provides guidance on how to meet the challenges and overcome barriers to implementing a performance code in Colorado.

Performance Septic Systems: Does an Advanced Septic System Provide Adequate Treatment on Black Hammock Island and is there Adequate Regulatory Policy to Ensure Integrity?

This project determined if the performance based septic system, proposed for a development on Black Hammock Island in Jacksonville, Florida, is the best choice to prevent environmental contamination from septic tanks and if adequate regulatory policy exists. Research shows a central wastewater treatment plant provides the most efficient pollutant removal but can be cost prohibitive. This project found performance based systems surpasses conventional septic system performance and are more suited and economical to remote areas without sewer service. This project finds current regulations to be inadequate and supports ordinance changes proposed by the Mayor of Jacksonville to enhance the current policy and provide more adequate and meaningful regulation.

National Conference on Less Costly Wastewater Treatment Systems for Small Communities, U.S. Environmental Protection Agency, Date: April 12, 13, and 14, 1977, Location: Reston, Virginia.

Mode of access: Internet.

Fate of priority pollutants in publicly owned treatment works : pilot study /

Mode of access: Internet.

Evaluation of operation and maintenance factors limiting municipal wastewater treatment plant performance /

Mode of access: Internet.

Handbook : estimating sludge management costs /

Mode of access: Internet.

Aguas e exgottos no Recife : (antigos servicos) /

Mode of access: Internet.

Process design manual for dewatering municipal wastewater sludges /

Mode of access: Internet.

Environmental monitoring of a wastewater treatment plant /

"Grant no. R805533."

Retrofitting POTWs /

"July 1989."

Handbook : improving POTW performance using the composite correction program approach /

Mode of access: Internet.

Odor and corrosion control in sanitary sewerage systems and treatment plants : design manual.

Mode of access: Internet.

The Effects of wastewater treatment facilities on wetlands in the Midwest /

Mode of access: Internet.

Evaluation of flow equalization at a small wastewater treatment plant /

Mode of access: Internet.