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The Institute of Health Systems

The Institute of Health Systems (IHS) Laboratory.

Laboratory service is a backbone of health systems. Laboratories play a vital role in clinical medicine and in public health.

A clinical or medical laboratory primarily serves patients to aid in diagnosis and treatment. Clinical laboratories are healthcare facilities that provide a wide range of laboratory procedures which aid the physicians in carrying out the diagnosis, treatment, and management of patients. The modern clinical laboratory emerged along with development of hospitals which could house and utilize developing diagnostic tools such as the microscope and X-ray. Today, most of the clinical laboratories are situated within or near hospital facilities to provide access to both physicians and their patients. Aside from its known value to individual patients, clinical laboratories do play a role in screening and surveillance of diseases significant to public health.

Public Health Labs.:Laboratories:Laboratories:

Public health laboratories emerged to investigate sanitary conditions of water supplies by laboratory methods. The realization that germs were responsible for epidemic outbreaks of infectious disease, coupled with development of microbiology tools and techniques expedited further development of public health laboratories, mostly established by municipal, state and national governments. Although almost all such laboratories were established by various public authorities, the key distinguishing feature of a public health laboratory is it scope. Public health laboratories primarily test environmental samples such as water, study spread of pathogenic microbes and viruses, and personal samples for purposes of screening for diseases, or to study transmission dynamics of epidemics.

Public health laboratories are vital for assessing, investigating, and analyzing the health needs, effects, and community health status. Public-health laboratories provide, what economists call, public goods to the community by way of outbreak investigation, epidemic surveillance, or epidemiologic research. This is the major reason why public-health laboratories developed largely in the public sector. State public health authorities have to function in sync with government policies and priorities. Although services of government public health laboratories are open to general public, access is often limited due to various factors.

During the course of preparing a manual for control of gastroenteritis commissioned by the Health Department of the Government of in Andhra Pradesh it was noticed that the capital city of Hyderabad, had the highest incidence of gastroenteritis in the state, despite substantive investments in water supply and sewerage systems. This triggered the idea of public health laboratory to enhance access and empower the general public in water quality monitoring. Purpose was to provide appropriate support for people's action towards improvement of people's health. Smt. G. Shyamala, who had recently retired as Chief Water Analyst from the Institute of Preventive Medicine, Government of Andhra Pradesh, joined the Institute on 20th Nov. 2003 and helped establish the Water Quality Testing service. The IHS Laboratory was inaugurated on 16th March 2004 by Sri JVR Prasada Rao, the then Secretary, Ministry of Health and Family Welfare, Government of India.

NABL Symbol

The IHS Laboratory is accredited by the National Board of Accreditation for Testing and Calibration Laboratories (NABL) India.

Lab Id: T-4179;

Certificate Number: TC-7658; Issue Date: 06-08-2022; Valid Until: 05-08-2024.

The IHS Laboratory is gradually developing itself as an easily accessible Public Health Laboratory for laboratory tests that are relevant to safeguarding and improvement of people’s health. Keeping with this objective, new test services are introduced to meet felt needs. The IHSL follows sound quality assurance mechanisms and adopts standard test methods for all tests including newly introduced tests. However, immediate accreditation by NABL may not be feasible, for various reasons. Thus, at any point of time, the laboratory would have a set of NABL accredited parameters, and other parameters for which NABL accreditation is not yet available. To avoid any misrepresentation, the IHSL we adopt a strict policy of using NABL symbol in test reports only if all test results included in the report are within the scope the accreditation. For more details see;
The IHSL Policy for Use of NABL Symbol and Claim of NABL Accreditation on Test Reports.

Water Quality Testing.

The IHS laboratory provides comprehensive facilities for testing water quality, including chemical and bacteriological analysis in the laboratory, field testing and sample collection services. Various water testing activities include; potable water testing service, municipal supplies and metro water testing, water testing for food safety and FSSAI licensing, ground water testing, RO water testing, bottled water testing, waste water analysis, effluent water tests, sewage treatment plant water tests, etc. Indian standard laboratory procedures and in certain cases, the American Public Health (APH) standards for testing of various water quality parameters. The Institute provides a wide range of accessible water quality testing and analytical services for public health.

Are you being served potable water?
How safe is the water you drink at home?
How good is your ground water?
How is the metro / municipal supply?
Is your groundwater good for gardening?
Do you really need a RO purifier?
What would be an appropriate water purifier for your needs?
Is your society sewage treatment plant working fine?
What can a water quality testing laboratory do?


Water quality testing at IHS laboratory word artWater quality testing at IHS laboratory word artWater quality testing at IHS laboratory word art

Which includes a wide range of test packages:

Drinking water quality tests such as; BCT, BPT, CPT, GPT, BWP, ROP, BSV.

Chemical quality tests such as; BQT, TQT, GQT.

Medical water testing such as; DRF, DLB, BET.

Enviornmental water analysis such as; SBP, SQT, SOD.

Waste water analysis such as; ETB, EWT, STE.

Construction & Industrial water analysis such as; WBC, WCT.

Swimming pool water testing such as; PST, PWC, PWB.

An Overview of Water Quality Related Activities at the IHS Laboratory:

Water quality related activities at the IHS Laboratory can be grouped into the following broad areas.

  1. Accessible Water Testing & Analysis for Public Health (AWTAPH).
    [Water Testing for General Public.]
  2. Institutional-Campus Water Quality Monitoring.
  3. Water Quality Monitoring (WQM) Services for Municipal Utilities.
  4. Consumer Complaints Surveillance (CCS) for Water Safety.
  5. Sanitary Inspection of Service Reservoirs for Water Safety (SISR).
  6. Focus Group Discussions (FGD) and Community Connect for Water Safety.
  7. Research and Collaborations for Water Safety.

Accessible Water Testing & Analysis for Public Health (AWTAPH):

[Water Testing for General Public]

Access to safe drinking-water is essential to health. Safe and readily available water is important for public health, whether it is used for drinking, domestic use, food production or recreational purposes. Contaminated water and poor sanitation are linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and polio. Absent, inadequate, or inappropriately managed water and sanitation services expose individuals to preventable health risks. This is particularly the case in health care facilities where both patients and staff are placed at additional risk of infection and disease when water, sanitation and hygiene services are lacking. Inadequate management of urban, industrial and agricultural wastewater means the drinking-water of hundreds of millions of people is dangerously contaminated or chemically polluted. Natural presence of chemicals, particularly in groundwater, can also be of health significance, including arsenic and fluoride.

The IHS Laboratory seeks to empower people by easily accessible to water quality testing services. Sample collection bottles with guides and appropriate carry bag are made available round-the-clock. Samples are also received 24 hours. Samples received after working hours are stored by watchman in freezers for analysis the next day. People inquire about water quality testing options at IHS through dial-in and online search platforms like JustDial, through the IHS website, and/or personally visiting the IHS. A service matrix showing the scope of various test-packages, their test codes and a guide for selection of test-packages is made available to all visitors to the Front office and through email to people inquiring online. Sample collection services are offered for a modest fee. Reports are being scanned and sent by e-mail, held for pickup or couriered depending on client-options.

Test-packages are designed for water from different sources for various uses. For example; the complete potability tests (CPT) includes a set of common parameters to test municipal water from surface water sources, to assess potability and fitness for domestic use. The groundwater potability tests (GPT) build upon CPT and includes some more parameters relevant for borewell water. The basic potability tests (BPT) includes a minimal subset of CPT/GPT to assess potability, at a lower cost. Clients can use GPT/CPT to benchmark their sources and then follow up with BPT at periodic intervals to ensure that their source continues to remain potable. As of February 2022, the laboratory tests catalogue includes multi-parameter 25 test packages, and 35 single or limited parameter test services. The multi-parameter test-packages include; bottled water potability (BWP), RO product water profile (ROP), surface water basic profile (SBP), basic (municipal water distribution) system vulnerability (BSV), dialysis RO system feed water (DRF), dialysis water basics (DLB), bacterial endotoxin (BET), (swimming) pool side tests (PST), effluent water (EWT), sewage treatment plant effluent (STE) tests, in addition to GPT, CPT and BPT mentioned earlier. The parameters included in various test-packages are tailored to facilitate interpretation with respect to the concerned source, treatment efficacy and intended use. For example; PST includes free, combined and total chlorine, relevant for adequate disinfection of contaminants from bathers in swimming pools. Effluent water tests (EWT and STE) include total suspended solids (TSS), biochemical and chemical oxygen demand (BOD, COD), Oil and grease, etc.

Notes and recommendations attached to test reports in a unique feature of water quality test services from the IHS laboratory. People usually have concern about safety and suitability of water for an intended use. For example; is this water safe to drink? ‘Can I use my borewell water for domestic purposes?’ Is it suitable for gardening? Some clients ask if their water suitable for poultry, fisheries or other animal feed. ‘What to do if my borewell water has a petroleum smell and a neighbourhood petrol pump might be responsible?’ Occasionally, a client may ask if the water suitable for a beauty-saloon, or to wash aircraft engines! A baker would be concerned about suitability of water for their operations and a food processing industry would want to know if the water is suitable for washing and cleaning of raw fruits and vegetables. Sometimes clients bring sample of water collected in their cellar and ask if they can put it to some use. To meet various client concerns, IHS faculty refer applicable standards, fact sheets, public health and/or environmental protection agency advisories, industry guidelines, etc. to offer notes and recommendations regarding suitability of the particular water sample submitted for analysis for their intended purpose.

In addition to fitness for purpose, IHS faculty try to diagnose, hypothesize or at least develop some conjectures about what could have contributed to observed deviations in water quality parameter values, and how to deal with the situation. For example; high turbidity in case of a recently drilled borewell may indicate that either well development was not done or is incomplete and/or mismatch between natural yield of the borewell and capacity of the pumping arrangement. The notes and recommendations would briefly mention about usefulness of well development and direct the client to literature that describes methods for well development. Clear water from a recently drilled borewell showing presence of coliforms may indicate contamination during drilling. In such cases, IHS notes and recommendations would advise about procedure for disinfection of the borewell using easily available household products for chlorination. Output from a water purifier with Ultra violet (UV), showing presence of total coliforms can be used for drinking, but presence of heterotrophic organism in the sample would indicate failing UV unit, and/or contamination from the dispense faucet.

Institutional-Campus Water Quality Monitoring:

Institutions and their campuses face a special challenge in ensuring water safety for their residents and visitors. Hospitals, for example, have to maintain elaborate water storage and distribution system with various point-of-use and/or point-of-entry water treatment facilities to supply drinking water to patients and attendants and meet for other medical uses such as for dialysis, sterilization units, operation theatres and general use in wards and outpatient departments. Acceptable chemical profile and bacteriological purity is important for hand wash and many other uses in hospitals. Similarly, in case training, research and educational institutions, potability of water supplied in campus is critical for health of the trainees, guests and in-campus residents. These moderately complex water storage, distribution and point-of-use treatment systems need regular monitoring to identify developing vulnerabilities, if any, for timely preventive measures.

To establish a tailormade water quality monitoring system for an institution, the IHS first takes up a sanitary survey of their water supply system to identify and map various components including sources (municipal supply and/or groundwater), sumps, overhead tanks, distribution system, point-of-use (POU) water treatment units, drinking water dispensing points, etc. Critical components of water sourcing, storage and distribution system are inspected. Based on a risk analysis of the system, and criticality of institutional operations, a water quality monitoring plan, including testing cycle, sampling plan, and periodical sanitary survey of the sumps, rooftop tanks, and borewell heads, etc. is proposed.

For example; the following table shows sample of a water quality monitoring plan for a 100-bedded nonprofit general hospital with dialysis services. This hospital sources municipal water through a 40 mm diameter pipe, supplemented by four borewells. There are five sumps. A RO plant delivers water for dialysis. About six POU units, located in various floors, deliver drinking water to patients and attendants.

Illustrative Water Quality Monitoring Plan for a Hospital Campus.
Sl Designated Use / Source Source / Sampling Bi-annual Benchmark Tests Monthly Monitoring
Test Code Qty Test Code Qty
1 Dialysis Water Feeder borewell / sump / overhead tank GPT 1 DRF 1
RO plant output, dialysis room ROP 1 DLB 1
Dialysis room taps BET 1 BET 1
2 Municipal supply for Drinking & General use Sump, OHT & General taps CPT 3 BPT 3
PoU treatment unit for drinking water CPT 1 BPT 1
3 Borewells for General Use Borewell, Sump, OHT & General taps GPT, CPT, CPT & BPT 4 CPT/BPT 3
4 Sample Collection Service 10 8
BPT: Basic potability test: designed to test for general characteristics, and a few chemical parameters (hardness, which is an indicator of mineral content) and microbial quality.
CPT: Complete potability tests designed to test for general characteristics, and more chemical parameters (Alkalinity, chloride and sulphates and microbial quality.
GPT: Groundwater potability tests designed to test for a larger set of chemical parameters, in addition to general and microbial characteristics for testing.
ROP: Reverse Osmosis water Profile.
DRF: Dialysis RO Feed water. DLB: Dialysis water Basics. BET: Bacterial Endotoxin Test for dialysis water.
Biannual benchmark tests should be done in April & October.
Monthly monitoring tests in other months. Samples from POU units should be rotated to cover each unit at least once during a semester. Samples from General Use Taps shall be rotated to cover at least one tap from each sump, OHT, floor and service area during a semester.

Similarly, a periodical sanitary survey plan shows for various types of campuses may look like the following:

Illustrative Annual Sanitary Survey Plan for a Hospital Campus
Sl Description Scope
1 Annual Sanitary Survey Inspect sumps, rooftop tanks, borewells, water dispensers and usage areas. Identify actionable issues to protect water quality and improve sanitary conditions.
2 Annual Follow-up Sanitary Survey Check for rectifications and follow-up action on Annual Sanitation Survey. Report extent of compliance and persistent actionable issues needing attention.

Water Quality Monitoring Services for Municipal Utilities:

Safe water refers to water that is not harmful for human beings, that is not contaminated to the extent of being unhealthy. Safe water also refers to water supply that is of sufficient quantity to meet all domestic needs, is available continuously to all and is affordable. Water that looks clean is not always safe for humans to drink. Sometimes it is hard to see the germs and bacteria that cause diseases as they cannot be seen with naked eyes. Often, these unseen organisms can make us very sick. They are especially dangerous for small children or the elderly and in some cases lead to death. So, one cannot assume that water is safe just because it looks clean. If drinking water comes from a polluted source and is untreated, it may contain germs and bacteria that can cause the spread of waterborne diseases like diarrhoea, typhoid and cholera. Treatment of water is a process of killing and removing harmful microorganisms in the water. Water treatment involves filtering or adding chlorine in order to kill or remove harmful bacteria, as well as to improve the colour, odour and taste of water. Small doses of chlorine is safe for humans, but deadly for bacteria.

The water quality monitoring program at IHS has developed in partnership with the Hyderabad Metro Water Supply and Sewerage Board (HMWSSB/MWB). This public-private partnership started in 2005, soon after establishment of the IHS Laboratory, and in the context of a jaundice outbreak in the old city area of Hyderabad . A few slum areas were assigned by the MWB for monitoring of water quality by the IHS. IHS water quality investigators (WQIs) tested for residual chlorine in all public standposts and pit taps in households. In addition, a random sample of house taps were covered. Samples for bacteriological and physicochemical analysis are collected from a smaller number taps tested for residual chlorine. Subsequently samples of stored water in households and drinking water from street vendors were included for a more comprehensive understanding of consumer exposure to drinking water quality.

Residual chlorine (RC) is tested using N,N-diethyl phenylene diamine (DPD) with calibrated color comparator, as recommended by the World Health Organisation (WHO). Previous methods involved the use of Orthotolidine and starch-potassium iodide. OT is now known to cause cancer and so is not recommended . Water quality investigators are trained to test for residual chlorine using DPD tablets and a laminated color comparator. The chemical unit of IHS Laboratory (aka ChemLab to IHS personnel) periodically conducts induction training in field testing of residual chlorine (FTRC) for new recruits, proficiency tests and refresher training at regular intervals for continuing staff. WQIs are provided with a specially designed bag to carry residual chlorine test kit, sampling-bottles, ice packs etc. Separate sampling bottles with unique identification (BottleId) labels are provided for physicochemical and bacteriological monitoring . Every WQI carries a smartphone with a mobile app to capture FTRC test data. The FTRC mobile app has been developed by the IHS on the Epi Info platform . A dedicated water quality monitoring chat group (WQM-chat-group) has been created on a social media group chat app for real time communication between WQIs, IHS water safety project coordinators (IHS-coordinators) and water utility quality assurance and testing (QAT) officers.

WQIs visit service reservoirs and residential neighbourhoods (identified slums) in their respective zone, for FTRC and collection samples for laboratory tests. Their working hours are synchronized with water supply timings in respective areas, to ensure testing of live municipal supply. Typically, WQIs start their day early. On any particular day a WQI would visit several service reservoirs and slum areas, and rotate daily visits to cover most of the services reservoirs and slum areas in the assigned zone. WQIs their first test result in the chat group to indicate their attendance. In the event of a no-residual-chlorine (No-RC) test result, post a message in the WQM-chat-group and sometimes may upload photos of test result/location etc. This enables QAT officers to initiate real time response through concerned operations personnel. At times, when there is any confusing or implausible posting in the WQM-chat-group, IHS-coordinators and QAT officers confer over telephone to resolve discrepancies, and establish factual position to facilitate appropriate action. In the event of a no-RC result at a service reservoir, WQIs inquire with operations personnel to ascertain reasons and report the same using a set of structured ‘RC Note’ and a free flowing ‘RC Remarks’ field in their mobile app. The structure ‘RC Note’ can be grouped into (a) Machine malfunction, (b) Operator error or no operator, (c) No chlorine gas, (d) No power, (e) Low level or no distribution etc. The WQI may record additional information in ‘RC Remarks’ to reconfirm or further explain the No-RC event. For example; when booster chlorination could not be done as there was no chlorine gas, the WQI would select ‘No chlorine gas’ in the ‘RC Note’ field and enter information about availability of spare cylinder in the ‘RC Remarks’ field. In case, a sample is collected for laboratory analysis the identification number captured in the mobile app for reference. WQIs collect samples for physicochemical testing and bacteriological analysis in accordance with a sampling plan, which allocates samples to various sources, namely; service reservoirs, water tankers, public standposts, pit taps, house taps, stored water etc. WQIs end their work shift by visiting the IHS Laboratory to deliver samples for laboratory testing and to synchronize FTRC data from mobile app with data processing unit. Occasionally, when there is no sample to deliver for lab testing, a WQI may send FTRC synchronization file by email, and retire for the day.

The ChemLab and microbiology unit of IHS Laboratory (aka BioLab to IHS personnel) process samples received from the field. The physicochemical monitoring (PCM) monitoring test package includes a core set of parameters to assess quality of municipal water. These include, (a) physical and sensory characteristics such as colour, odour, turbidity, total dissolved solids (TDS) and pH, and (b) chemical parameters such as alkalinity, hardness, ammonia, nitrites, nitrates, and chlorides. Colour, odour, turbidity and TDS indicate aesthetic quality of municipal supply. pH and alkalinity are operational parameters for safe passage in distribution system. Ammonia, nitrite, nitrates and chlorides would indicate intrusion of sewage or organic leachates into the distribution system. Hardness, would indicate domestic usability and implications for maintenance of household appliances. In addition, fluorides are included in the PCM test-package for Hyderabad Metro Water, because fluorosis is a regional concern.

Bacteriological contamination monitoring (BCM) test-package for municipal water includes estimation of most probably number of total coliforms [MPN(TC)/MPN], thermotolerant coliforms (TTC), and E. coli. Most total coliform bacteria (excluding Thermotolerant coliforms & E. coli) are normal inhabitants of soil and water environments. Total coliforms can also survive and grow in water distribution systems, particularly in the presence of biofilms. Hence, Total coliforms are useful as an indicator to assess the treatment effectiveness, cleanliness and integrity of distribution systems and the potential presence of biofilms. Plenty of total coliforms in distribution systems, despite booster chlorination, may be due to biofilms, inadequate booster chlorination, and/or excessive ambience temperature. Hence, QAT officers are advised to investigate locations showing plenty of total coliforms, to rule out operational deficiencies, if any.

Thermotolerant coliforms, other than E. coli may originate from organically enriched water such as industrial effluents or from decaying plant materials and soils, as well as animal and human faeces. In temperate climate, surface water concentrations of thermotolerant coliforms are directly related to E. coli concentrations. But in tropical and subtropical surface waters, such as in Hyderabad, thermotolerant coliform bacteria may occur without any obvious relation to human faecal pollution. Hence TTC alone do not indicate faecal contamination. However, presence of TTC in treated water should not be ignored, as the basic assumptions that pathogens may be present, and that treatment has been inadequate still holds good. Hence, QAT officers are advised to view TTC as an operational indicator of system integrity. Presence of E. coli is a definitive indicator of faecal contamination.

These core set of parameters mentioned above have been chosen for cost-effective and sustainable routine monitoring of municipal water quality. These parameters would not detect contamination with industrial effluents, heavy metal or pesticide intrusion etc. Special tests will have to be done when and where such contamination is suspected. Both units of the laboratory share test results in a spreadsheet to the data processing unit and IHS coordinators on the same day when results are available.

The data processing officer(s) gather FTRC data files from all WQIs, laboratory test results from BioLab and ChemLab and prepare a daily report to the Water Utility’s QAT officer concerned. The daily report provides a summary of BCM activities, identifies BCM test results that may be of some concern, BCM sample-wise statement, a summary of FTRC activities, statement of No-RC cases, and statement of PCM test results. A structured algorithm is followed to report about quality of water based on BCM test results, indicating cases of operational concern and unsatisfactory test results if any.

QAT officers inform operations personnel about cases of concern and unsatisfactory BCM test results are, so as to identify contamination vulnerabilities and for appropriate remedial action. Strict adherence to booster chlorination protocol often resolves many contamination concerns. Sometimes SR cleaning, protection & proper maintenance would help. Occasionally, repair or replacement of distribution lines may be required. The net result of all such interventions would be clearance of bacteriological contamination in follow-up samples.

In addition, IHS coordinators watch for BCM test results to focus on cases indicating faecal contamination and inquire about concerned sampling points. WQIs revisit the concerned household or service reservoir as the case may to gather circumstantial evidence and contextual information that may provide some clue regarding source of contamination. For example; WQIs would ask the concerned household and in the neighbourhood, if they have noticed any discoloration, foul smell, or turbidity in municipal supply, if they have experienced sewerage overflows in the area or if there is any recent damage or repair to water pipeline in the neighbourhood etc. A brief summary of the follow-up inquiry is incorporated in the ‘BCM Remarks’ column of the concerned daily report. The revised daily report is forwarded to QAT officers drawing their attention to specific changes in the revised daily report. The PCM test results are watched by IHS coordinators looking for signs of sewage contamination if any. For example, very high TDS, coupled with high levels of chlorides, presence of ammonia and nitrites would indicate some intrusion. In our experience such deviations in chemical profile are very rare. None the less, IHS coordinators actively watch for such events, so that follow-up samples can be tested to reconfirm altered chemical profile and sources of contamination, if any, can be investigate. The data processing unit consolidates the daily report once in a week and at the end of every month. The weekly and monthly reports are forwarded to water utility QAT department for managerial review and future planning purposes.

The annual report of water quality monitoring activities summarises FTRC, PCM and BCM data for the year, analyses trends with respect to previous year, documents insights gained from WQM activities during the year, identifies areas of concern, and suggests operational improvements for consideration of senior management. This report also provides descriptive summary statistics of physicochemical profile and microbial purity of water supplied to consumers in monitored areas, during the year. The IHS Laboratory supported the Hyderabad Metro Water Supply and Sewerage Board (HMWSSB) as an independent (third party) water quality monitoring agency from 2005 to 2021. The Water Quality Monitoring activities were resumed from March 2023.

Consumer complaints surveillance for water safety:

Consumers may become aware of potential problems with the safety of their drinking-water because of their own senses or informal networks. To a large extent, consumers have no means of judging the safety of their drinking-water themselves, but their attitude towards their drinking-water supply and their drinking-water suppliers will be affected to a considerable extent by the aspects of water quality that they are able to perceive with their own senses. It is natural for consumers to regard with suspicion water that appears dirty or discoloured or that has an unpleasant taste or smell, even though these characteristics may not in themselves be of direct consequence to health. Trust and goodwill from consumers are extremely important in both the short and long term. Consumers have an important role to play in assisting the authorities in an incident by their own actions and by carrying out the necessary measures at the household level.

Components of a Contamination Warning System for Water Utilities.
Schematic diagram showing componets of a contamination warning system

Source: Fig-F2 in USEPA. Water Security Initiative: Interim Guidance on Developing an Operational Strategy for Contamination Warning Systems. Washington DC, USA: United States Environmental Protection Agency (USEPA); 2008 Oct.

Consumer feedback and complaints provide utilities with useful data about consumer perceptions of aesthetic water quality in the distribution system. Consumers as real-time sensors are uniquely positioned to provide feedback. These feedbacks may be specific such as chlorine smell or general such as "polluted water", "bad smell", etc. A responsive consumer-complaints handling system is an essential aid to development and implementation of water safety plans. The idea of such a surveillance system emerged out of a pilot study of selected consumers who had registered repeated complaints with the Metro Consumer Complaints (MCC) system of the Hyderabad Metro Water Supply and Sewerage Board (HMWSSB).

The sample size for consumer complaints surveillance system would depend on availability of funds and the granularity of desired estimates. A minimum sample size of about 1200 consumer complaints per year was considered appropriate for robust organisation-wide estimates annual estimates and to build-up more granular estimates by cumulating date for several years, as the system gets established. The sample size is distributed month-wise, for concurrent operation of the CC surveillance system and balance estimate based on consumer experiences throughout the year. At first, each sampled consumer is approached to obtain informed consent for the survey. Sometimes a consumer may refuse consent to proceed with the survey, after the informed consent process. Rarely a consumer would consent, and the survey would progress to some extent but remain incomplete on account of unexpected circumstances. All such cases are reported to the project coordinator, who would either find a solution to proceed with the survey, and where this is not feasible, would authorise replacement samples.

A basic system vulnerability (BSV) test-package has been designed to help identify distribution system vulnerabilities for environmental and sewage contamination.

Basic Vulnerability Test Parameters to help identify vulnerabilities in distribution system to environmental and/or sewage contamination.
Sl Parameters Rationale for inclusion of the parameters.
1 General Color, Odour, Turbidity, pH & TDS Backsiphonage is sometimes associated with disagreeable odor (drainage or sewage smell), increased turbidity, and TDS.
2 Chemical Ammonia, Nitrites & Nitrates; Chlorides. Excess of ammonia; (a) is an important indicator of faecal pollution, (b) affect taste & smell, and (c) reduce efficiency of chlorination, as up to 68% of the chlorine may react with the ammonia and become unavailable for disinfection. High level nitrites and nitrate indicate probable environmental and sewage contamination. Nitrites indicate recent contamination. Nitrates indicate older contamination. Presence of both may be due to a continuing source of contamination. Chloride in drinking-water originates from natural sources, sewage and industrial effluents.
3 Microbial MPN (Total Coliforms), Thermotolerant & E. coli. Plenty of total coliforms indicates that there may be some issues regarding cleanliness and integrity of the distribution system. Presence of thermotolerant coliforms suggests environmental pollution including the possibility of sewage contamination. Presence of E. coli is a definitive sign of sewage (fecal) contamination.

The survey instrument has been designed to help with a structured and detailed conversation about consumers' experience of the complaints-resolution process. In addition, this survey provides a cost-effective opportunity to gather primary data regarding domestic water storage infrastructure, water handling practices and domestic sewage systems, and the state of street sewers nearby the sampled consumer premises. The Survey Instrument includes, (a) questions to gather information from the consumer/informant, (b) rating scales to measure informant’s assessment of water utility response to their complaints, and (c) items for recording surveyor's observation of domestic water supply and sewage system. The instrument was fine-tuned during the course of survey, based on field experiences and additional information needs.

Before embarking on the survey, the Water Quality Investigator (surveyor) visits the concerned MWB - Section Office to, inform about the survey, identify the service reservoir that supplies to the sampled consumer, gather information about the distribution line to the sampled consumer. Sometimes, people at Sections Office may also help with directions to locate the consumer premises. Surveyors visit the concerned consumer premises, twice. First, to locate the consumer premises, identify an appropriate respondent, gather detailed information regarding the water quality complaint and fill in the consumer survey instrument. Information regarding water supply timing is gathered at this time. If, by chance, there is live metro water supply at the time of first visit to sampled consumer's premises, the surveyor would test for residual chlorine and collect a sample for laboratory analysis. Mostly, however, the surveyor makes a follow-up visit, during the water supply timings, to test for residual chlorine and collect a sample of metro water supplied to the consumer (live supply) for laboratory testing. Occasionally, particularly if the supply times are from midnight to early morning, the surveyor would give a presterilised sample collection bottle to the informant/consumer, explain the procedure and request him/her to collection a sample of metro water during live supply. In such cases the surveyor visits the household the next day morning to collect the water sample and deliver it to the IHS laboratory for testing. On the spot testing for residual chlorine would not be feasible for these cases. The surveyor also visits the concerned service reservoir, preferably within the scheduled supply time for the sampled household, tests for residual chlorine and collects a sample for laboratory analysis.

These studies show that most of the water supply related complaints fall into four categories, namely; no-water (36%), water leakage (23%), distribution issues (20%), and polluted water (16%). About 85% of consumers evaluated MWB response as 'satisfactory' or better (good, very good and excellent). About 95-98% complaints were attended to within the maximum of 15 days specified in the citizen's charter. About 74 to 85% complaints were attended to within 5 days. However, persistence and recurrence of problems is a major concern. About 87% households have sumps and/or overhead tanks for bulk storage, mostly of metro water. Overall, sanitary conditions of most sumps & OHTs are reasonably good. However, about 5.2% sumps and 6.7% overhead tanks in consumer premises are vulnerable to contamination from bird droppings. Heavy to very heavy sedimentation was seen in 1.1% sumps and 2% OHTs. Algae was noticed in about 1% of sumps and 1.6% of OHTs indicating availability of nutrients and entry of sunlight. Overall, most households are maintaining their sumps and OHTs to prevent recontamination. However, sump/OHT maintenance practices in a small proportion of households are deficient. About 6% to 8% households leave some opening to their sump/OHT.

Most importantly, the survey shows that, consumer confidence on potability of metro water is quite high. About 86% households are relying on MWB supply as the primary source of drinking water for their households. Aesthetic quality of metro water supplied to consumers in Hyderabad has generally been quite good. About 99.8% of samples from both SR & households satisfy the acceptable criteria for colour and odour. About 99% of metro water supplied to households in Hyderabad tested during the 3-year study period was found to be very palatable (TDS ≤ 500mg/L). The incidence of microbial contamination reduced over the 3-year period from 2017-18 to 2019-20, with resultant improvement in quality of water delivered by the MWB. The number of SR samples that did not grow any coliforms at all increased from 83.92% in 2017-18, to 96.3% in 2019-20. Similarly, the number of household samples without any coliforms increased from 79.75% in 2017-18, to 92.08% in 2019-20. There was significant reduction in environmental / faecal contamination events compared with the previous years.

Overall, the HMWSSB is supplying excellently palatable, aesthetically acceptable, contamination free potable water in 97% cases. Most of the contamination is attributable to issues with distribution pipeline or consumer connection pipe line.

Sanitary Inspection of Service Reservoirs (SISR) for Water Safety

Water utilities usually source raw water from surface water bodies such as dams & reservoirs or by directly pumping from rivers. Sometimes groundwater may also be used. In any case, raw water has to be processed and treated before it is ready for distribution to consumers. Adequate volume of treated water has to be safely stored for distribution to consumers. The storage facility for distribution of treated water, called distribution reservoirs are also known as service reservoirs, finished or treated water storage etc. Service reservoirs are located close to consumer areas to maintain effective pressure in distribution lines.

The purpose of sanitary inspection is to check all aspects of a service reservoir (SR) to rule out vulnerabilities and pathways of contamination, if any. The inspections are designed to identify structural and/or operational deficiencies, if any and recommend measures to improve sanitary integrity, and minimise risk of contamination of water stored and distributed from the SR. For example; SRs with unprotected air vents and/or open manholes would be vulnerable to bird droppings. Unprotected side-wall air vents and walk-in access ways may allow birds to nest, which in turn increases vulnerability for bird droppings. Leaks and gaps around inlet, outlet, overflow arrangements can create vulnerabilities for entry of contamination to the distribution system. Defunct inlet/outlet pipes and cul-de-sacs can provide niches for growth biofilms. Close examination of the SR exterior may give clues regarding vulnerabilities for contamination. For example; inadequately drained roofs allowing for accumulation of storm water that pickup contamination from bird the roof surface into the SR interior through cracks, gaps etc. around air vent pipes, manholes, entry/exit of various pipes etc. Cracks, crevices and/or water marks on the SR walls may indicate junctional voids that may eventually allow for entry of contamination. Condition of the surrounding land may indicate some vulnerability. For example, if the surrounding land is not sloping towards the SR instead of sloping outward, storm water would accumulate around the SR structure, which in turn would affect structural and functional integrity of the SR. Similarly, information about the latest and previous cleaning operations, booster chlorination, and time trend analysis of water quality monitoring results for the concerned SR may give some clue about operational vulnerabilities, if any. Water safety surveyors are trained to inspect and gather information about air vents, manholes, inlet-outlet arrangements, state of roof & walls, surroundings, history of cleaning, and chlorination arrangements. Reports are prepared based on their initial inputs and follow-up visits for further clarifications. Each report provides actionable recommendations to address sanitary deficiencies, if any and improve operational integrity of the SR. Sanitary inspection reports should clearly identify and provide feasible and actionable recommendations that can be taken up by operations and maintenance (O&M) personnel without. The protocol for sanitary inspection, and preparation of reports IHS was developed by pilot testing of designed forms and guidelines on several SR and fine-tuned based on experiences from inspection of 73 services reservoirs, as of August, 2021.

Focus groups and community connect for water safety

The objective of the community mobilisation is to develop strategies for water safety in slum areas of Hyderabad and build community awareness among the slum residents. Focus group discussions (FGDs) are conducted regularly in identified slum areas to gather information about consumer perceptions of metro water supply through domestic connections, public stand posts and tankers and to understand consumer concerns on water availability, regularity, and quantity of supply. FGDs also help to understand community knowledge, attitudes and practices about water quality and related issues, usage, storage, handling, hygiene, sanitation, and health status. In addition, the FGDs are used to inform & educate the target group on good hygiene practices and measures to prevent waterborne diseases. Water safety surveyors, fellows/interns, research assistants, associates, faculties, and other personnel drawn from various sections of the Institute are trained in focus group methodology (Scrimshaw and Hurtado, 1987) and water sanitation and hygiene concepts (CAWST, 2017; WHO, 2015; UNICEF, 2011) to act as FGD resource persons. Two resource persons are drawn for each focus group, one to act as a facilitator and the other as recorder. Monthly about five FGDs are being conducted in different slum areas of Hyderabad. and reports were submitted to HMWSSB for follow up action.

Research and collaborations for water safety

Often the IHS Laboratory collaborates with other organisations taking up mostly action research projects that require water quality testing. Following are some examples of collaborative project in which the IHS Laboratory has participated.

Institute of Perception Studies and IHS: Water quality in and around Hyderabad

Institute of perception studies Institute of Perception Studies (IPS) is a Delhi based non-profit organisation and works for poverty alleviation and rural and urban distress reforms. IPS undertakes research on rural and urban distress. As part of research, IPS took up the study to know the water quality in the borewells and in direct supply of municipal water in and around Hyderabad. IPS has approached IHS to test the water including interpretation for their assessment. The study has been started in Aug 2021.

EPTRI and IHS: Status Report on State Specific Action Plan for Water Sector: Telangana State

The Environment Protection and Training Institute (EPTRI) was commissioned by the Government of Telangana to prepare the state specific action plan for water sector as in accordance with the terms of reference (ToR) issued by Government of India, Ministry of Water Resources, River Development & Ganga Rejuvenation. As a part of this activity, EPTRI had to prepare a status-, interim- and final-reports in three phases. By May 2017, EPTRI had prepared draft of the first phase stratus report. The Institute of Health System contributed towards finalisation of this stage by taking up a detailed review of the draft status report with specific inputs for finalisation of the report.

Fresh Water Action Network, South Asia and IHS: Study on Sanitation, Wastewater and Septage Management

Fresh Water Action Network (FWAN), South Asia in collaboration with National Institute of Urban Affairs (NIU), GoI has initiated a study on Sanitation, Wastewater and Septage Management systems on a pilot basis across 5 States in the country including Telangana to strengthen its SCBP (Sanitation Capacity Building Platform) initiative. Siddipet town has been selected for the project in Telangana for the assessment. As part of the assessment, the study team requested IHS in 2018 to undertake water quality testing in various locations of Siddipet town for; (1) Ground Water Potability (GPT)Test for the water from Borewells, (2) COD and BOD for the water from Lakes or rivers. IHS has collected 9 samples for GPT and 5 for COD and BOD and furnished the reports for the assessment by FWAN.

Center For People’s Forestry and IHS: Drinking water quality in rural area

Center For People’s Forestry (CPF) working for Promoting capacities, diversifying skills, and enhancing livelihood security of the marginalised sections among the forest and rural communities. Before planning an intervention, CPF carries out action research to understand the situation at all levels, identify gaps and define the role to be played by CPF and other stakeholders in it. As part of the action research, CPF commissioned IHS in 2017 to test the water samples in rural areas to know the water quality for drinking. IHS has tested 55 water samples for Ground water potability collected from borewells in Achampet and Adilabad areas of Telangana and gave the interpretation on the suitability of water for drinking.

Gurunanak Institutions - Civil Engineering Dept. and IHS: Water quality in a watershed area

Civil Engineering Department of Gurunanak Institutions, Ibrahimpatnam of Ranga Reddy district took up the study under UGC Minor Research Project to know the water quality in Eliminetivagu watershed area. The institute has commissioned IHS in 2016 to collect the samples from borewells in the villages falling in water shed area for ground water quality test. IHS has collected 30 water samples, tested for GQT and furnished the reports to include in their study report.

Center for World Solidarity and IHS: Potability of Groundwater in Anantapur and Warangal Districts

In 2014, the Center for World Solidarity (CWS) wanted to test for potability of groundwater (GPT) in various gram panchayats of Anantapur and Warangal districts. This was an action research project on sustainable groundwater management (SuGWM). Their team was trained by IHS, in water sample collection, storage and transportation to laboratory. After training they were provided with sample collection bottles, along with written guides for reference, samples to laboratory within 24 hours. All 47 samples were received from them were tested reports furnished to CWS for appropriate intervention.

World Vision India and IHS: Safe drinking water in remote areas using locally sourced groundwater and reverse osmosis (RO) technology

In 2014, the World Vision India (WVI), had a project to deliver safe drinking water in remote areas using locally sourced groundwater and reverse osmosis (RO) technology. The IHS laboratory deployed water quality investigators to collect sample from the field, transport them to laboratory in appropriate packing, analyse and furnish test results to WEVI. Samples were collected from 35 villages in Bhokpur block of Nanded district of Maharashtra, and 12 villages in Korukonda Mandal of East Godavari district. More samples were collected in 2016 to 2017, from Kandukur in Prakasam District, Vijayanagaram, Achampet/Shadnagar area of Mahbubnagar district and a few from Hyderabad city. The main idea of this project is to plan for establishing RO Plants where the ground water was not safe to use, so that the individuals can have access to safe water for drinking and other domestic purposes.

RWTH Aachen University, Germany and IHS: Scenario Analysis for Protection of Water Resources with Regard to Urban Development in Varanasi and Hyderabad

Ms. Nina Engels, was a student of RWTH Aachen University, Germany who was pursuing post-graduation in Geo-resources Management took up the research topic, “Scenario Analysis for Protection of Water Resources with Regard to Urban Development in Varanasi and Hyderabad”. For her research topic, she focused on urban development, in particular water quality and water supply. She designed the study which includes taking water samples from different study areas all around the cities from public hand pumps, taps, rivers, lakes and private bore wells, so as to cover nearly all sources where people in India get their water from. On request from Ms.Nina Engels, IHS has accepted the job and deputed the water quality investigators for collection of samples at the sources which were identified by Ms. Nina Engels. She impressed about the standard procedure of preparation of sample collection kit, skills in collection of water samples by the water quality investigators during accompanying the investigators. The sampled water bottles were transported within six hours and deposited at the IHS laboratory for testing. The test reports were prepared and furnished for each sample to Ms. Nina Engels for including the thesis.

IIT Delhi, ICRISAT and IHS: Study on Manjira River Watershed

Study on Godavari River basin and the Manjira river watershed for the effects of climate change A pilot drainage (sub-basin) of the Godavari river basin, namely the Manjira sub-basin has been selected by IIT, Delhi for development of scenarios and impact assessment. As part of the pilot study, IIT Delhi has approached the Institute of Health Systems in Sep 2010 for sampling of water in the Manjira river basis for testing various parameters. At the local level, the scientist from ICRISAT has coordinated with IHS on behalf of IIT Delhi. IHS has collected the samples and tested for surface profile test including COD and BOD (got tested from other labs). The test results were disseminated to IIT Delhi to include in the study.