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Partnerships for enhanced engagement in research (PEER) SCIENCE
Cycle 2 (2012 Deadline)

Development and field testing of high performance aluminium oxide-based technologies for fluoride removal in the Ethiopian Rift Valley

PI: Feleke Beshah (Addis Ababa University)
U.S. Partner: David Sabatini (University of Oklahoma)
Project Dates: August 2013 to June 2017

Ethiopia Partnership Picture 1

The Ethiopian research team at Addis Ababa University (Photo courtesy Dr. Beshah).
The available technologies used for removing fluoride from water such as reverse osmosis, activated alumina, and synthetic resins are difficult to implement in Ethiopia due to their high cost, the need for skilled manpower for system operation and maintenance, and the challenges of ensuring a continuous supply chain for the required chemicals and materials. Relatively simple and low-cost technologies such as the Nalgonda technique and bone char have been tried in Ethiopia, but they have proven inefficient under the prevailing water quality conditions. The objective of this study is to develop, characterize, and evaluate the effectiveness and sustainability of innovative high-capacity aluminum oxide-based materials, composite oxides, and impregnated high surface area adsorbent based technologies for fluoride removal in rural villages of Ethiopia. The project will also look at socioeconomic and entrepreneurial aspects to find ways to make the technologies sustainable in the Ethiopian context. Besides laboratory-based synthesis and characterization of adsorbents, the project will include preliminary field testing of the new materials, as well as assessment of socioeconomic and social entrepreneurship factors and presentation of findings in workshops and training sessions.
According to a recent estimate of the Ethiopian Ministry of Water and Energy, more than 11 million people in Ethiopia are at risk of high fluoride in drinking water in the Rift Valley region. More than 80% of children in the country suffer various degrees of dental fluorosis, and skeletal fluorosis is increasing among adults and the elderly. Thus, there is a pressing need for low-cost, high-capacity, and sustainable water treatment technologies for fluoride removal. For these technologies to be sustainable, they must be efficient, locally available, economically and socially viable, and simple to operate and maintain. While motivated by challenges in rural villages of Ethiopia, the results of this project will also benefit those living in rural communities of other East African countries impacted by fluoride. This project also has an important goal of capacity and human resource development for fluorosis mitigation in Ethiopia. The participation of the Ministry of Water Engineering and relevant NGOs will help to consolidate ties between research and implementation. The results will be disseminated to the scientific community through publications in reviewed journals, and a national workshop is planned to communicate the results to various stakeholders involved.

Summary of Recent Activities
Dr. Beshah' original grant was awarded to develop, characterize and evaluate the effectiveness and sustainability of innovative high capacity aluminum oxide based materials
and composite oxides for fluoride removal in rural Ethiopia. The project aimed at socioeconomic and entrepreneur aspects to find ways to make the technologies sustainable in Ethiopian context. The aim of the supplement award was  to undertake further assessment on how to scale up fluoride treatment technologies in rural Ethiopia. The defluoridation technologies implemented and tried by various organizations in Ethiopia are not yet proved to be sustainable due to inadequate capacity of the organizations dealing with the technologies, lack of understanding of the limitations associated with the technologies, affordability and lack of awareness by the users, and absence of proper material supply chain either through the government channel or by private sectors or in partnership.

At the end of his project, he was awarded an evidence-to-action supplemental grant to carry out further studies to develop a concise strategy document for scaling up the fluoride removal technologies in collaboration with relevant stakeholders to ensure sustainability of the technology. The concise strategy document will help to scale up the fluoride removal technologies among fluorosis-affected rural communities in Ethiopia. The strategy will also be important in addressing issues related to availability of materials, simplicity of technologies to apply in rural villages, affordability, awareness creation and promotional activities.

The following activities were carried out during the award period:
• A concise stakeholder analysis has been performed outlining both a categorical and individualized map of institutions and persons relevant in implementation of fluoride removal technologies (drivers for scaling up).
• The water, health and education bureaus in four fluoride affected regional states (Afar, Oromia, Southern Nation, Nationalities and Peoples Region, and Somali) were visited.
• Representative fluoride affected woreda, Kebeles or communities in each regional state were visited.

The main objective of the field visits in the sample areas was to conduct situation or stakeholder analysis, to assess the situation of field implemented technologies and to carryout socioeconomic survey. Regional Water Bureaus were involved in selecting the assessment sites. The space for scaling up has been defined with need assessments: need can be analyzed in terms of: e.g. water resources for which fluoride removal is a suitable and a cost effective solution; readiness of local Government bodies and water bureaus to support the implementation of fluoride removal technologies, etc. 

Document review was also an important source of data to capture the existing gaps for scaling up the fluoride removal technologies in rural villages in Ethiopia. With this in mind, policy/strategy documents, programs and action plans were reviewed intensively in order to come up with proper strategy document and the way forward. This includes, but not limited to, Health Policy of Ethiopia, National Fluorosis Mitigation Strategy of Ethiopia (2013), Growth and Transformation Plan 2 (GTP-2) 2015/16-2019/20, Ethiopian Water Resources Management Policy, Ethiopian Water Sector Strategy (2001), National Compulsory Drinking Water Standard (NCDWSS), One WASH National Program (2013), and documents of National Fluorosis Mitigation Project Office (such as a document depicting Spatial Distribution of Fluoride in the Ethiopian Rift and its adjacent Highlands) were key documents for this study.

Cognizant of the fact that fluorosis is a serious public health problem affecting the national development, the Ministry of Water, Irrigation and Electricity (MoWIE) has established a National Fluorosis Mitigation program which is aiming at the implementation intervention measures including implementation of Water Defluoridation Technologies. Recently, the NFMPO and other NGOs particularly the Oromo Self Help Organization (OSHO) and the Catholic Relief Service (CRS) Ethiopia are making efforts to implement water defluoridation technologies in rural areas both at household and community scales. The key issue related to the ongoing technological interventions is ensuring the overall sustainability and building local capacity.

In Addition, USAID supports the Government of Ethiopia’s efforts by incorporating water, sanitation and hygiene activities into its health, education, humanitarian assistance and democracy and governance programs, and water resources management into its agriculture and food security activities. Among many other large scale programs and projects, USAID provided a grant of USD $500,000 to OSHO which has been used for the installation of 12 community scale fluoride removal units based on bone char and production system of hydroxyappatite material in Modjo over a period of 2 to 3 years starting from early 2014. The output of this project will have strong impact on the USAID’s support to Ethiopia to enhance access to safe drinking water in the Ethiopian Rift Valley where at least 14 million people are at risk of dental, skeletal and systemic fluorosis. The strategy for scale up can be used all implementing partners.

The output of this project will also have an impact on water science and technology education and research in Ethiopia. The problem of fluoride in particular and water quality in general will be included in graduate curriculum which in the process of development with financial support from the World Bank through soft loan mechanism for the Government of Ethiopia. The Ministry of Science and Technology of Ethiopia also developed an interest to support further field testing and dissemination of fluoride treatment technologies. 

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