A R T I C L E  I N F O		ABSTRACT
SYSTEMATIC REVIEW		Introduction: The water safety plan is a systematic approach that aims to ensure the quality of water distributed to consumers. In 2004, the World Health Organization issued a statement implementing the water safety plan. The plan is underway in Iran. The purpose of this study is to review the studies conducted from 2004 to 2020. Materials and Methods: Present article is a systematic review study to search for keywords in a combination of "water safety plan" (WSP), "Iran", "Hazard Analysis and Critical Control Points", (HACCP) and "water" in international databases including: PubMed, Science Direct, Google Scholar, as well as national databases include: Magiran and SID. Results: In the initial search, 671 articles were found that after screening based on the Prisma checklist, 15 articles were included in the study for further review. The results showed that in the implementation of WSP, the highest score is related to Qom city with 68.64% and the lowest value is related to Khoy city with 17.5%. Improvement and upgrade program, support program development, and review of WSP courses have received less attention. Low staff familiarity with WSP, insufficient team composition and lack of coordination between them in holding regular meetings can be the reason for poor implementation of WSP in Iran. Conclusion: The full implementation of the water safety plan controls the risks in the water supply system and reduces costs, as well as improves and increases the quality of water distributed to consumers.
Article History: Received: 02 March 2021 Accepted: 20 April 2021
*Corresponding Author: Rahim Aali Email: Aali1400@gmail.com Tel: +982537842227
Keywords: Water Safety Plan, Systematic Review, Iran.

Introduction
Water resources are one of the main factors of sustainable development in any society and in addition to quantity, it is very important to perusal its quality ¹. Lack of needed water resources has always affected the lives of humans, plants and animals in many countries, including Iran and this problem is considered as one of the indicators of economic and agricultural development in any country ². Therefore, in 2010, the United Nations recognized access to safe water as a human right due to the importance of the issue ^{3, 4}. According to World Health Organization (WHO) statistics in 2016, the majority of disease outbreaks and about 3.3% of deaths in the world (about 2 million out of 123 million deaths per year) were due to lack of access to safe water ^{5, 6}. These statistics always show the impact of natural and unnatural factors on water resources and may have irreversible effects on the health of people in any society. Therefore, one of the main concerns of managers and officials supplying safe water is monitoring the potential risks, protecting the public health of water distribution network consumers, and ensuring that all members of the community have access to adequate and safe water ^6-8. One of the most effective ways to ensure the safety of drinking water is to use a comprehensive method of risk assessment and risk management that identifies and controls the critical points and hazards that threaten the water supply system from the Catchment to the point of consumption ^{7, 9-11}. Such an approach is called the Water Safety plan (WSP) ¹². Water safety plan is a tool that provides principles for risk management practices such as Hazard Analysis and Critical Control Points (HACCP), multiple barrier modeling, and risk assessment ¹³. WSP is a preventive management approach and consists of three main components; the goals are based on health, a safe water plan and an independent monitoring system ^9-11. For this reason, this plan is superior to traditional methods of water quality assessment. In the traditional method, sampling and analysis of results is time consuming and always reports past water quality. Therefore, it is not able to detect the occurrence of accidents and hazards in the water supply system and cannot reduce the subsequent consequences ^14,15. Due to the importance of the issue, WHO ordered the implementation of the water safety plan in 2004 ¹⁶. Since then, the implementation of the WSP has been considered in various ways by the world's water authorities, which are implemented by 93 countries. In 69 other countries, such as New Zealand, Belgium, Germany, Italy, Sweden and the United Kingdom, they are being developed as a regulatory or mandatory policy ^17,18. Iran is currently implementing WSP ⁹. The first published study of the use of WSP in Iran was conducted by Jahed et al. The present study is a review of WSP studies conducted in Iran. The results and recommendations collected from this study can be compared with studies in other countries and show the main obstacles to the application of this program in Iran. It also identifies key risk factors in aquatic systems in which WSP has been implemented.
Materials and Methods
Search strategy
Considering that 2004 was recognized by the WHO as starting point for the implementation of WSP, English and Persian articles published from January 1, 2004 to November 1, 2020, that included WSP applications in Iran, via searches in international databases including PubMed, Science Direct, Google Scholar and national databases including Magiran and SID were identified. The key words searched in this study were included "water safety plan", "WSP", "Iran", "hazard analysis and critical control points", "HACCP" and "water". The search strategy consisted of combinations of these words (in both English and Persian). Prisma checklist principles were used to articles screening process.
Inclusion and exclusion criteria of the study
Articles that met the following criteria were eligible for inclusion in the study; 1- Studies conducted in the time limit of 2004 to 2020, 2- Original studies, 3- Existence of full text, 4- Performed in Iran, 5- Use the semi-quantitative risk matrix method recommended by WHO to assess the risk of water systems.
Data extraction and analysis
An Excel data entry form was developed. Data structure includes; name of authors, year, language of study, province and urban or village, type of water system, risk management method and WSP impact assessment. Two researchers independently checked the data extraction forms for accuracy and completeness. Finally, the extracted data includes; results of the general evaluation of the steps of WSP, the progress rate information of WSP, provincial distributions of reported studies, prioritization and risk assessment of the most important hazardous event, was analyzed by Excel software. In this study, 15 articles were included.
Results
A review of published WSP studies in Iran
In this study, during the initial search according to figure 1, 671 articles were found, and after removing the duplicate results, 652 items were selected. The titles and abstracts of 652 articles were reviewed by researchers to identify their relevance to the subject of study. Based on the inclusion and exclusion criteria, 54 studies were selected for full text review, of which 38 articles were excluded from the study due to non-Iranian and one article due to not using the WHO recommended risk matrix. Finally, 15 articles were included in the study for further review that implemented WSP, Risk Assessment, and HACCP program. According to the results extracted in table 1, out of 15 selected papers, 8 had implemented WSP, 5 had performed risk assessment and 2 had implemented HACCP. 11 studies have been published in English and 4 studies in Persian. The reported WSP studies have been performed on surface and groundwater systems, which include a total of 291 water supply systems, 7 surface water supply systems, 280 wells and 4 springs. More studies have been conducted in urban areas and only one case is dedicated to village areas, indicating that more studies have focused on large-scale (urban) water systems and less on small-scale (village) scales.
In terms of geographical distribution, studies have been conducted in 10 provinces of the country, mostly in the central provinces, including; Qom, Isfahan, Semnan, Zanjan and Hamedan (n = 7), northwestern provinces including; Ardabil, East Azerbaijan and West Azerbaijan (n = 5) and the east of the country include; the provinces of Khorasan Razavi and South (n = 3). Provincial dispersion of published studies is shown in figure 2. As can be seen, no report of WSP studies has been published in the northern and southern provinces of the country.
Table 2 shows the results for the scores obtained in the 10 WSP steps for 11 studies. Studies have shown that in most studies except Hamedan and Qom, some WSP steps have not been performed and have not scored. These steps are shown in the table as a dash.

Figure 1: Papers screening process for eligible studies

Reference	Risk management method	WSP impact evaluation method	Type of water systems	Urban or village	Province	Language	Author, year	No of Study
19	HACCP	Water quality test	Surface water	Germi city	Ardebil	English	Jahed et al, (2009)	1
17	HACCP	Water quality test	Surface water	Isfahan city	Isfahan	Persian	Bina et al, (2010)	2
13	WSP	Water quality test	24 wells	Khoy city	West Azerbaijan	Persian	Boodaghi et al, (2011)	3
20	Risk Assessment	Water quality test	Surface water	Ardebil city	Ardebil	English	Mahvi et al, (2014)	4
21	WSP	Water quality test	Spring and well	Lighvan village	East Azerbaijan	English	Mosaferi et al, (2014)	5
9	WSP	Water quality test	32 wells	Birjand city	South Khorasan	English	Fanaei et al, (2015)	6
22	WSP	Water quality test	4 wells	Sarayan city	South Khorasan	Persian	Fanaei et al, (2015)	7
23	Risk Assessment	Water quality test	Ground water (65 %, 56 wells) and surface water (35 %)	Zanjan city	Zanjan	English	Sohbatloo et al, (2016)	8
24	WSP	Water quality test	13 wells	Qom city	Qom	English	Shafie et al, (2016)	9
25	Risk Assessment	Water quality test	Surface water (70 %) and ground water (30 %, 115 wells)	Hamadan city	Hamadan	English	Hassanzadeh et al, (2016)	10
26	Risk Assessment	Water quality test	Spring and well	Semnan city	Semnan	English	Razmju et al, (2017)	11
27	Risk Assessment	Water quality test	Ground water and surface water	Qom city	Qom	English	Shafie et al, (2017)	12
28	WSP	Water quality test	23 wells	Torbat-e-Jam city	Razavi Khorasan	Persian	Barikbin et al, (2018)	13
29	WSP	Water quality test	12 wells	Bukan city	West Azerbaijan	English	Fanaei et al, (2019)	14
30	WSP	Water quality test	Surface water  and ground water (Treated using reverse osmosis system)	Qom city	Qom	English	Ghafuri et al, (2017)	15

Figure 2: Provincial distributions of the reported studies in Iran
Table 2: Results of the general evaluation of the Steps of the WSP for the drinking water supply system in Iran

Results (%)												Steps  of  WSP	No. of  steps
Hamadan	Zanjan	Ardebil	Semnan	Bukan	Birjand	Torbate-Jam	Khoy	Sarayan	Qom (2016)	Qom (2017)
85	30	40	90	65	60	10	30	70	65	95	WSP team		1
75	100	62.5	100	73	87.5	50	62.25	50	100	100	System description		2
86	79	32	52	51	52	52	12	59	97	100	Hazard identification and risk assessment		3
17.65	35	17.65	19.12	48.2	64.71	39.71	8.82	48.53	63.24	50	Control measures and validation		4
32.25	38	-	-	-	-	18.75	-	-	25	25	Improvement plan		5
62.5	38	0.25	14.06	42.7	67.19	51.56	31.25	51.56	75	25	Operational monitoring		6
28.13	63	50	68.75	75.2	71.88	25	78.5	78.13	96.88	12	Verification		7
77.78	92	11.11	44.44	52.9	25	66.67	-	58.33	38.89	47	Management procedures		8
87.5	63	-	75	12	-	-	-	-	78.5	25	Supporting programs		9
-	29	-	21.43	17	-	-	-	-	51.79	-	Review of the WSP		10
50	52.95	21.14	35.45	43.7	43.18	36.14	17.5	42.95	68.64	48.18		Total (%)

Figure 3: Results of the progress rate information of WSP in drinking water supply system in Iran
 

Review of risk assessment in published studies
According to the 5 × 5 risk rating matrix recommended by WHO (Table 3), the results of the study of important risks; that are analyzed and interpreted; presented in table 4. In this table, risk factors and risk events are classified as very high and high risk. These factors and events were selected in 291 Water systems and 15 studies.

Severity or consequence Likelihood or frequency	Insignificant or no impact - Rating: 1	Minor compliance impact -Rating: 2	Moderate aesthetic impact - Rating: 3	Major regulatory impact - Rating: 4	Catastrophic public health impact - Rating: 5
Almost certain/ Once a day- Rating: 5	5	10	15	20	25
Likely/ Once a week- Rating: 4	4	8	12	16	20
Moderate/ Once a month- Rating: 3	3	6	9	12	15
Unlikely/ Once a year- Rating: 2	2	4	6	8	10
Rare/ Once every 5 years- Rating: 1	1	2	3	4	5
Risk score	< 6	6- 9	10- 15	> 15
Risk rating	Low	Medium	High	Very high

In a water safety plan, risk refers to all the potential biological, physical, chemical, and radiological hazards that may be associated with water supply or quality. While dangerous accidents can directly and indirectly cause water pollution. Risk assessment can be classified into four levels according to the risk score: Low (< 6), Medium (6–9), High (10–15) and Very high (≥16). (Table 3)
In drinking water quality management, it is sometimes difficult to differentiate the risks, and therefore all events with very high risk and high risk are summarized in Table 4 in this article. According to the results of the study, the most important hazards that have been determined with a very high risk rating in the source, distribution network and point of consumption are; in water resources; discharge of sewage and garbage into the catchment area by villagers and local communities, in the water distribution network; problems with clarifiers and overflows for treatment, inability of manpower, equipment and facilities in specialized operations and at
the point of consumption include; lack of performance in the drainage system for tanks, well construction at home and low consumer awareness.

Corrective actions	Risk assessment				Dangerous event	Danger	Location
	Risk rating	Risk	Possibility	Severity
Construction of treatment plant, Increasing villagers awareness about the risks of discharge into water/catchment area 20, 25	Very High	20	5	4	Discharge wastewater and solid waste in catchment area by Villagers	Physical, chemical, biological	Source water
Check existing wells exactly and schedule for monitoring and regular upgrades 23, 26	High	10	2	5	Corrosion or incomplete wall inside the well
Provide adequate credit for installing equipment, use of portable laboratory devices until the installation of online devices 26	High	15	3	5	Lack of quality online monitoring system	Physical
Watershed and flood control in catchment area, Deviations of local floods, storage of water in dam or source 23	High	12	4	3	Floods resulted from seasonal rainfall and change in quality and quantity of water source
Construction and management of treatment plant and applying fines in the event of drainage into the water 25	Very High	20	5	4	Wastewater of mining	Chemical
Collection and management of agricultural runoff and encouragement farmers to replace chemical fertilizers with green fertilizers 23	Very High	16	4	4	Release of Pesticides and fertilizers  in catchment area
The removal of polluted wells from consumption cycle and replacing with better sources, Collection of wastewater and Using supporting pipes for wastewater exclusion wells, Combination of high nitrate water with sources of low nitrate 23	High	12	3	4	High concentration of nitrite and nitrate
Draining the pond periodically, Inspection and maintenance of all utilities especially of overflows, Analysis of the cavitation’s and decay 27	Very High	20	4	5	Problems in clarifiers and overflows	Physical, chemical, biological	Treatment process
Alarm systems installation, Monitoring and inspection, Utility safety analysis and elimination of defects in periodic times 27	High	15	3	5	Leakage of chlorine gas	Chemical
Create an appropriate water backwash and Change of filters on time 25	High	12	3	4	Blockage of filters	Chemical, biological
Passive control (local action for elimination of daily incidents), Active control (regular and continuous leakage detection plan), Renewal of network (replacement of pipes and other compartments), Management of network pressure, Management of executive operations of the network 23	High	12	3	4	Entry of polluted water to distribution network during an incident such as explosion, disruption, leakage or water supply pipelines repair	Physical, Chemical, biological	Water distribution
Replacing worn pipes, Continuous inspection 20, 25	High	15	5	3	Old pipes and infrastructure	Physical, biological
Installing the panel in the Length of the distribution network, Preparing Geographic Information System (GIS) map for Pipe Line, Coordination with relevant departments to create facilities 25	High	12	3	4	Fracture of pipes due to the installation of facilities and excavation	Physical, chemical
Education of operational staff in applying chlorine,  Super chlorination in pipes or sources, Further disinfection through the path by booster dosing 20, 23	High	12	3	4	Inadequate residual chlorine in sources and distribution network	Biological
Moving the water transmission path, Install leak detection systems 25	High	10	2	5	Proximity the sewage line with distribution pipe
Monitoring and recording the amount of pressure and maintaining sufficient pressure on the network 25, 26	High	12	3	4	Pressure fluctuations and Pressure drop	Physical
Determining the status of the valves and recording as a comprehensive plan, determining the exact location of the drain valve according to the test results of the blind and the endpoints of the network 26	High	12	3	4	Lack of proper number of water drainage valves
The use of mainline repair manuals, Establishment of training classes to increase the level of technical and specialized expertise 26	Very High	16	4	4	Personneldisability, equipment and facilities in specialized operations
Installation of cut off valve at the end of inlet line and protection against pollution 27	Very High	20	4	5	Malfunction in draining system	Physical	Reservoirs
Provide adequate credit for equipment installation 26	High	10	2	5	Lack of equipment quality online
Elimination of defects by the expert, the expert at recruiting and defect fixes 26	High	12	3	4	Damaged electrical equipment
Periodic visits to the facility and Peripherals materials in the tank repairs, especially lions and Peripherals 26	High	12	3	4	Damage mechanical equipment
Close monitoring of equipment and storage of consumables 26	High	10	2	5	Inefficiency of diesel generator
Prevent the construction wells, Informing on the dangers of using such wells 25	Very High	16	4	4	Construction of wells in home	Chemical	Point of use
Raising awareness between consumers, Developing the educational programs for children and teenagers, by presenting correct ways of consumption management, beliefs, attitudes, and as a result the citizens' manner toward ways of consuming drinking water has to be changed, Appropriate and honest informing of consumers, Reforming of consumers' life style, Legal and controlling actions 23	Very High	16	4	4	Low awareness of consumer	Physical, biological
Immediate investigation of the cause or causes of water quality changes and other qualitative complementary analyzes to reach the desired results, investigating consumer complaints about water quality, Addressing and solving problems, providing educational package for consumers in order to protect their water safety in the field of health, proposing sound and safe methods. To replace the water supply section 26	High	12	3	4	Lack of consumer satisfaction of the water quality and the use of alternative sources	Physical, chemical, biological

• A good opportunity to upgrade the water supply system of urban and villages
• Inefficiency of the traditional approach in urban and villages
• The most effective tool for ensuring safety in drinking water supply
• Covering the water safety plan from the catchment area to the point of consumption
• Involvement of all relevant and relevant institutions in the implementation of WSP
• Improve the quality of distributed water
• Increase consumer satisfaction
• Reducing water-borne diseases
• Ensure a continuous supply of safe water
• Strict implementation of the water safety plan will increase public health, improve management efficiency and investment.

• Non-implementation of water safety plan in all cities and villages of Iran
• Relying on final tests
• Partial implementation of the water safety plan and failure to complete the steps in the guidelines of WHO
• Lack of awareness of the high importance of implementing a water safety plan for water and wastewater managers and employees
• The relevant institutions are governmental and do not convene regular meetings
• Lack of holding water safety plan training courses and familiarity of its importance for employees by relevant institutions
• Economic problems and insufficient funding to continue the program
• Lack of attention of the authorities to the implementation of WSP at the national and provincial levels

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