Risk management for drinking water safety in low and middle income countries - cultural influences on water safety plan (WSP) implementation in urban water utilities

Cultural Values in Water Management and Governance: Where Do We Stand?

Research in water governance and management is a complex subject that involves the appraisal of social, economic, and environmental–biophysical aspects. Cultural and social values are regarded as key drivers in decision-making processes in both domains. Identifying relevant cultural values however is difficult given the interdisciplinary nature of theoretical frameworks and the implementation and operational needs of water governance/management research. In this work, we conduct a systematic literature review and thematic analysis of existing theories of culture (ToC) to identify common cultural values, theoretical frameworks, disciplinary trajectories and implementation trends relevant to water management and governance. Results indicate that the dominant ToC corresponds to Cultural Theory with its four defined categories (Egalitarian–Hierarchist–Individualist–Fatalist). In addition, results show emergent cultural values linked to “local” place-based knowledge perspectives indicating a more pluriversal understanding of cultural values. Cultural values associated with water management revolve around anthropocentrism, whereas values associated with water governance revolve around concepts of provenance/places. Implementation of ToC/cultural values is limited in practical applications, and we provide an example on how to improve on that. We suggest a succinct theory of culture such as Schwartz’s cultural values be considered to be an alternative to capture a greater heterogeneity across the breadth of water governance/management-related and basin-specific contexts.

Risk assessment and water safety planning for rural water supply in Uttarakhand, India

A water safety plan (WSP) has been developed for rural water supply in Dehradun district, Uttarakhand, India. Four public water utilities were chosen to demonstrate the application of WSP in improving the rural drinking water quality along with improved sanitation. Hazard identification and risk assessment carried out identified 10 hazardous events at all four utilities. Intermittent water supply, poor repair and maintenance of the supply channel machinery, and individual household sanitation practices were the potential sources of contamination. The study showed encouraging results, where the evaluated risks decreased substantially after implementing the control measures, along with improved water quality after WSP implementation which showed statistically significant results (p < .05) for all tested parameters, namely, turbidity (p = .000), total dissolved solids (p = .004), residual-free chlorine (p = .004), total coliforms (p = .000), and fecal coliforms (p  = .003). The sanitation condition of water source and households also improved by adopting the suggested measures. The study recommends water safety planning, to empower the rural communities to safeguard their water sources, and for sustainable water supply management.

Financial, institutional, environmental, technical, and social (FIETS) aspects of water, sanitation, and hygiene conditions in indigenous - rural Indonesia

Background

There is increasing recognition of the complexity underlying WASH conditions in developing countries. This article explores the complexity by assessing the vulnerability of a specific area to poor WASH conditions using a qualitative approach.

Methods

We present our findings for the district of East Sumba in Indonesia. This area is known as one of the poorest regions in Indonesia with inadequate WASH services, indigenous belief that hinder the practice of WASH-related behaviours, and has a high rate of children malnutrition. All the factors that contribute to poor WASH conditions were discussed through the lens of the Financial, Institutional, Environmental, Technological, and Social (FIETS) framework. We then summarised the factors and visualized the “system” using a mind map which shows how factors are interconnected and helps to find the root causes of poor WASH conditions.

Results

There are three main challenges that inhibit the improvement of WASH conditions in this area: inadequate institutional capacity, water scarcity, and poor socio-economic conditions. We found that a village leader is the most important actor who influences the sustainability of WASH services in this area and healthcare workers are influential WASH promoters. This study also shows how culture shapes people’s daily lives and institution performance, and influences the current WASH conditions in East Sumba. The mind map shows there is an overlap and interconnection between FIEST aspects and WASH conditions in the study area.

Conclusion

WASH conditions are influenced by many factors and are often interconnected with each other. Understanding this complexity is necessary to improve WASH conditions and sustain adequate WASH services in developing countries. Finally, WASH interventions have to be considerate of the prevailing cultural practices and should involve multidisciplinary stakeholders.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11800-x.

Water Safety Plans and HACCP implementation in water utilities around the world: benefits, drawbacks and critical success factors

Drinking water is of paramount importance for people's health. Many outbreaks due to poor water quality are being recorded even nowadays. Although the institutional framework exists at global (e.g., WHO guidelines) and national level, there are still many factors contributing to water contamination. Risk assessment tools, such as HACCP and Water Safety Plans, are being elaborated all over the world to act proactively referring to drinking water quality. The present paper aims at reviewing the implementation status of risk assessment tools around the world and presenting the benefits and the difficulties recorded during the implementation process. The benefits include improved water quality, improved operational efficiency, reduced consumers' complaints, reduced production cost, and reduced potential hazardous incidents. Studying the difficulties, the identification of critical success factors for the implementation of such tools is feasible. Some of the critical success factors include the financial and human resources, staff training, effective identification of critical control points, correct estimation of the occurrence and the severity of the hazards, effective coordination, and efficient monitoring.

Whither regulation, risk and water safety plans? Case studies from Malaysia and from England and Wales

We explore the interplay between preventative risk management and regulatory style for the implementation of water safety plans in Malaysia and in England and Wales, two jurisdictions with distinct philosophies of approach. Semi-structured interviews were conducted with 32 water safety professionals in Malaysia, 23 in England and Wales, supported by 6 Focus Group Discussions (n = 53 participants). A grounded theory approach produced insights on the transition from drinking water quality surveillance to preventative risk management. Themes familiar to this type of regulatory transition emerged, including concerns about compliance policy; overseeing the risk management controls of regulatees with varied competencies and funds available to drive change; and the portfolio of interventions suited to a more facilitative regulatory style. Because the potential harm from waterborne illness is high where pathogen exposures occur, the transition to risk-informed regulation demands mature organisational cultures among water utilities and regulators, and a laser-like focus on ensuring risk management controls are delivered within water supply systems.

Multilocus-based phylogenetic analysis of extended-spectrum beta-lactamase Escherichia coli O157:H7 uncovers related strains between agriculture and nearby water sources

This study aimed to uncover related strains of extended-spectrum beta-lactamase Escherichia coli O157:H7 between agricultural matrices (soil, manure and irrigation water) and nearby water sources using multilocus-based phylogenetic analysis. Resistant and nonresistant E. coli O157:H7 were isolated, identified and characterised using standard microbiological methods. The results showed that soil samples had a high prevalence of E. coli O157:H7 (31.73%) and ESBL-producing E. coli O157:H7 (22.11%). Multilocus sequencing typing (MLST) analysis revealed that all ESBL-producing E. coli O157:H7 were identified as ST11. Phylogenetic analysis of E. coli O157:H7 indicated that irrigation water might be a reservoir for E. coli O157:H7. For antibiotic-resistant genes (ARG), the most common was bla_TEM in 85% (n = 34), followed by bla_OXA in 70% (n = 28), bla_NDM and sul1 30% (n = 12) and lastly mcr-1, which was only found in one soil isolate. The results showed that ESBL-producing E. coli O157:H7 isolates were intermixed in three clades, indicating close relatedness between isolated strains from different matrices.

Reducing Groundwater Contamination from On-Site Sanitation in Peri-Urban Sub-Saharan Africa: Reviewing Transition Management Attributes towards Implementation of Water Safety Plans

High urbanization in Sub-Saharan Africa (SSA) has resulted in increased peri-urban groundwater contamination by on-site sanitation. The World Health Organization introduced Water Safety Plans (WSP) towards the elimination of contamination risks to water supply systems; however, their application to peri-urban groundwater sources has been limited. Focusing on Uganda, Ghana, and Tanzania, this paper reviews limitations of the existing water regime in addressing peri-urban groundwater contamination through WSPs and normative attributes of Transition Management (TM) towards a sustainable solution. Microbial and nutrient contamination remain prevalent hazards in peri-urban SSA, arising from on-site sanitation within a water regime following Integrated Water Resources Management (IWRM) principles. Limitations to implementation of WSPs for peri-urban groundwater protection include policy diversity, with low focus on groundwater; institutional incoherence; highly techno-centric management tools; and limited regard for socio-cultural and urban-poor aspects. In contrast, TM postulates a prescriptive approach promoted by community-led frontrunners, with flexible and multi-domain actors, experimenting through socio-technical tools towards a shared vision. Thus, a unified risk-based management framework, harnessing attributes of TM and IWRM, is proposed towards improved WSP implementation. The framework could assist peri-urban communities and policymakers in formulating sustainable strategies to reduce groundwater contamination, thereby contributing to improved access to safe water.

Comprehensive Risk Assessment of Health-Related Hazardous Events in the Drinking Water Supply System from Source to Tap in Gaza Strip, Palestine

Background

The traditional approach in the management of the quality drinking water, and relying on end-product testing, has proven ineffective in protecting public health. Therefore, the transition to a systematic approach in drinking water supply systems management from the source to the consumer tap was taken as a water safety plan (WSP).

Objective

The study aims to investigate the health-related hazardous events in order to decide on the best risk-reduction strategies in the supply of drinking water in the Gaza strip.

Methods

A semiquantitative matrix method for risk assessment was applied. Also, chlorine residual, electrical conductivity, and nitrate concentration further tested in 109 water wells, 109 small-scale water desalination plants, 197 tanker trucks, and 384 households distributed over five governorates of the Gaza strip.

Results

The mean of the measured chlorine residual values was less than the recommended national and international limits (0.2–1 mg/liter). The mean of electrical conductivity at catchment points and household municipal water taps was 2165.1 μS·cm⁻¹ and 2000 μS·cm⁻¹, respectively. Furthermore, zero percent of water samples met the recommended criteria, indicating that the groundwater in the Gaza strip is nonpotable. Only 12.8% and 8.8% of water samples met the permissible levels at catchment areas and municipal water at household, respectively, indicating sever health impacts on the public. Moreover, the most hazardous events were related to high levels of groundwater salinity, the low level of disinfection, the effect of electricity outages on the efficiency of the desalination process, and leakage of water from the tanker truck tank reservoirs. Therefore, urgent interventions are required to improve the quality of water and to mitigate the possible health effects.

Conclusion

The prioritization of hazardous events that are proportional to the degree of their attributed risk could help guide in making the right risk-reduction decisions. Urgent interventions are required to improve the quality of water and to mitigate the possible health effects.

Status of Water Safety Plan Development and Implementation in Uganda

Uganda was among the first countries in Africa that pioneered Water Safety Plan (WSP) development and implementation, with the first WSP dating back to 2002. The objective of this study was to assess WSP status in Uganda, focusing on the experience of the National Water and Sewerage Corporation (NWSC), in order to understand the factors that influenced it and strategies for scaling-up. This study consisted of a review of documentation for 20 WSPs, 42 interviews, a focus group discussion and four field visits. Results show that the development of the 20 WSPs over the last 15 years was largely incomplete and diverse. Most of the WSPs focused on system assessment and improvement, but failed to include WSP monitoring, verification and management. The monitoring of control measures was implemented in nine of the 20 systems, while verification took place in the form of internal (5/20) and external (2/20) auditing. The main barriers identified to WSP implementation were inadequate training, team composition and deployment, mistaken perception and inability to evaluate WSP effectiveness. Conversely, the main enabling factors were management commitment, public health responsibility, good customer relations, financial availability and reliable laboratories. These findings suggest a need for more institutionalization of WSPs with improved coordination across stakeholder groups.

Adapting Translational Research Methods to Water, Sanitation, and Hygiene

Translational research applies scientific techniques to achieve practical outcomes, connecting pure research and pure practice. Many translational research types have arisen since the mid-1900s, reflecting the need to better integrate scientific advancement with policy and practice. Water, sanitation, and hygiene (WaSH) development efforts have aimed to reduce morbidity and mortality and improve service delivery; thus, associated research has a strong orientation toward applied studies that use diverse methods to support decision-making. Drawing from knowledge that emerged to support other professional fields, such as manufacturing and clinical healthcare, we characterize different types of translational research and clarify nomenclature and principles. We describe study approaches relevant to translational research questions, and offer overarching recommendations, specific examples, and resources for further study as practical advice to professionals who seek to apply translational methods to WaSH problems. To enhance collective outcomes, professionals should mindfully align projects within the translational spectrum. We further recommend overarching good practices such as documenting intervention adaptations, overtly considering contextual factors, and better distinguishing efficacy from effectiveness research by replicating studies in different contexts. By consciously improving the compatibility and linkages between WaSH science and practice, this guide can accelerate urgently needed progress toward global development goals.

Capacity building and training approaches for water safety plans: A comprehensive literature review

The World Health Organization has recommended Water Safety Plans (WSPs), a holistic risk assessment and risk management approach, for drinking-water suppliers across low-, middle- and high-income countries, since publishing its 2004 Guidelines for Drinking-Water Quality. While rapid WSP adoption has occurred, capacity is still catching up to implementation needs. Many countries and regions lack case examples, legal requirements, and training resources for WSPs, corresponding to widespread capacity shortfall in the water supply sector. We undertook a comprehensive review of the literature on capacity building and training for WSPs, with the goal of providing recommendations for multiple stakeholder groups at the scales of individual utilities, national governments, and intermediate units of governance. We propose a WSP training taxonomy and discuss it in relation to the stages of learning (introduction, practice, and reinforcement); describe the importance of customizing training to the target group, local language and circumstances; highlight the relevance of auditing for evaluating change over time; and call for robust methods to monitor WSP capacity development.

Treatment of rural domestic wastewater using multi-soil-layering systems: Performance evaluation, factorial analysis and numerical modeling

The discharge of wastewater in rural areas without effective treatment may result in contamination of surrounding surface water and groundwater resources. This study explored the wastewater treatment performance of multi-soil-layering (MSL) systems through interactive factorial analysis. MSL systems showed good performances under various operating conditions. The COD and BOD₅ removal rates in MSL systems could reach 98.53 and 93.66%, respectively. The performances of MSL systems in TP removal stayed at high levels ranged from 97.97 to 100% throughout the experiments. The NH₄⁺ - N removal rates of the well performed MSL systems reached highest levels ranging from 89.96 to 100%. The TN removal rates of aerated MSL systems ranged from 51.11 to 64.44% after 72 days of operation. The independent effects of bottom submersion, microbial amendment and aeration, as well as most interactions were significant. The performance of MSL systems was mainly affected by bottom submersion and aeration as well as their interactions. Aeration was the most positive factor for the removal of organic matter, TP and NH₄⁺ - N. However, oxygenated environment was unfavorable for NO₃^- - N removal. In the submerged area with limited oxygen, the microbial transformation of NO₃^- - N still occurred. A stepwise-cluster inference model was developed for tackling the multivariate nonlinear relationships in contaminant removal processes. The results can help obtain a better understanding of the complicated processes among contaminant removal in MSL systems.

Assessing operational performance benefits of a Water Safety Plan implemented in Southwestern France

AIMS

The World Health Organization (WHO) has recommended Water Safety Plans (WSPs) since 2004 as a means to reduce drinking water contamination and risks to human health. These risk management programs have shown promise across several potential areas of evaluation, such as economic benefits and regulatory compliance. Since WSPs are largely carried out by people who interact with water treatment equipment and processes, operational performance indicators may be key to understanding the mechanisms behind desirable WSP impacts such as water quality and public health improvement.

METHOD

This study reports performance measures collected at a WSP implementation location in southwestern France over several years.

RESULTS

Quantitative assessment of performance measures supported qualitative reports from utility managers. Results indicate significantly reduced duration of low-chlorine events at one production facility and a significant decrease in customer complaints related to water quality, manifesting reported improvements in operational performance and the customer service culture.

CONCLUSION

The findings demonstrate some success stories and potential areas of future performance tracking. Cyclical iteration of the WSP can help to achieve continuous quality improvement. Successfully applied evaluation criteria such as the number of water quality complaints or alarm resolution time might be useful across other locations.

Measuring the Impacts of Water Safety Plans in the Asia-Pacific Region

This study investigated the effectiveness of Water Safety Plans (WSP) implemented in 99 water supply systems across 12 countries in the Asia-Pacific region. An impact assessment methodology including 36 indicators was developed based on a conceptual framework proposed by the Center for Disease Control (CDC) and before/after data were collected between November 2014 and June 2016. WSPs were associated with infrastructure improvements at the vast majority (82) of participating sites and to increased financial support at 37 sites. In addition, significant changes were observed in operations and management practices, number of water safety-related meetings, unaccounted-for water, water quality testing activities, and monitoring of consumer satisfaction. However, the study also revealed challenges in the implementation of WSPs, including financial constraints and insufficient capacity. Finally, this study provided an opportunity to test the impact assessment methodology itself, and a series of recommendations are made to improve the approach (indicators, study design, data collection methods) for evaluating WSPs.

Effects of the Use of Ornamental Plants and Different Substrates in the Removal of Wastewater Pollutants through Microcosms of Constructed Wetlands

The high costs involved in treating wastewater are problems that developing countries confront, mainly in rural areas. Therefore, Constructed Wetlands (CWs), which are composed of substrate, vegetation, and microorganisms, are an economically and ecologically viable option for wastewater treatment in these places. There is a wide variety of possibilities for substrates and ornamental plants that have not yet been evaluated to be implemented in future CW designs. The goal of this study was to evaluate the process of adaptation and removal of wastewater pollutants in CW microcosms using different terrestrial ornamental plants (Lavandula sp., Spathiphyllum wallisii, and Zantedeschia aethiopica). Those plants were sown in two types of substrate: red volcanic gravel (RVG) and polyethylene terephthalate (PET). CWs with vegetation reduced 5-day biochemical oxygen demand (BOD5) by 68% with RVG substrate and 63% with PET substrate, nitrates 50% in RVG substrate and 35% in PET substrate, phosphates 38% in RVG substrate and 35% in PET substrate, and fecal coliforms 64% in RVG and 59% in PET substrate). In control microcosms without vegetation, reductions were significantly lower than those in the presence of plants, with reduction of BOD5 by 61% in RVG substrate and 55% in PET substrate, nitrates 26% in RVG substrate and 22% in PET substrate, phosphates 27% in RVG substrate and 25% in PET substrate. Concerning fecal coliforms 62% were removed in RVG substrate and 59% in PET substrate. Regarding the production of flowers, Lavandula sp. did not manage to adapt and died 45 days after sowing and did not produce flowers. Spathiphyllum wallisii produced 12 flowers in RVG and nine flowers in PET, while Zantedeschia aethiopica produced 10 in RVG and 7 in PET. These results showed that the use of substrates made of RVG and PET is a viable alternative to be implemented in CWs. In addition, the reuse of PET is an option that decreases pollution by garbage. The plants Spathiphyllum wallisii and Zantedeschia aethiopica remarkably contribute in the removal of pollutants in wastewater. Additionally, the use of ornamental plants, with commercial interest such as those evaluated, enables an added value to the CW to be given, which can be used for flower production purposes on a larger scale and favor its acceptance within rural communities.

Application of ozonation for pharmaceuticals and personal care products removal from water

Due to the shortening on natural water resources, reclaimed wastewater will be an important water supply source. However, suitable technologies must be available to guaranty its proper detoxification with special concern for the emerging pharmaceutical and personal care products that are continuously reaching municipal wastewater treatment plants. While conventional biological systems are not suitable to remove these compounds, ozone, due to its interesting features involving molecular ozone oxidation and the possibility of generating unselective hydroxyl radicals, has a wider range of action on micropollutants removal and water disinfection. This paper aims to review the studies dealing with ozone based processes for water reuse by considering municipal wastewater reclamation as well as natural and drinking water treatment. A comparison with alternative technologies is given. The main drawback of ozonation is related with the low mineralization achieved that may lead to the production of reaction intermediates with toxic features. The use of hydrogen peroxide and light aided systems enhance ozone action over pollutants. Moreover, scientific community is focused on the development of solid catalysts able to improve the mineralization level achieved by ozone. Special interest is now being given to solar light catalytic ozonation systems with interesting results both for chemical and biological contaminants abatement. Nowadays the integration between ozonation and sand biofiltration seems to be the most interesting cost effective methodology for water treatment. However, further studies must be performed to optimize this system by understanding the biofiltration mechanisms.

Water quality, compliance, and health outcomes among utilities implementing Water Safety Plans in France and Spain

Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240K manual samples and 1.2M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher's exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes.