Seasonality, water use and community management of water systems in rural settings: Qualitative evidence from Ghana, Kenya, and Zambia

Identifying predictors of E. coli in rural household water in sub-Saharan Africa using elimination regression

Exposure to fecally contaminated drinking water contributes to the global disease burden, especially in sub-Saharan Africa (SSA). We used cross-sectional data and elimination regression analysis to examine factors influencing E. coli contamination in household drinking water samples from 4,499 rural households in nine countries in SSA (Malawi, Mozambique, and Zambia in Southern Africa; Ghana, Mali, and Niger in Western Africa; and Kenya, Rwanda, and Tanzania in Eastern Africa). The proportion of household water samples containing E. coli was 71%, ranging from 45% (Malawi) to 89% (Tanzania). Pooled and multi-country predictive logistic regression models showed that using an unimproved-type water source, the absence of a community water committee, and domestic animal ownership were significantly associated with household drinking water contamination. Household water treatment and storage practices, sanitation and hygiene practices, and payment for drinking water were not significantly associated with E. coli contamination in any model. The season was a significant predictor of E. coli in the pooled model; samples collected in the rainy season were 2.3 [2.0, 2.7] times as likely to be contaminated with E. coli. Practitioners and policymakers should prioritize implementing piped on-plot water services, establishing effective local water source management structures, and incorporating animal husbandry practices into water, sanitation, and hygiene interventions.

Sand dam contributions to year-round water security monitored through telemetered handpump data

Sand dams are a form of rainwater harvesting, prolific in arid and semi-arid lands. Water is provided partly via handpumps, which, as the only improved method of abstraction from sand dams, are important for drinking water security. Accelerometers and cellular transmitters were fitted to 30 handpumps by the Africa Sand Dam Foundation (ASDF) in 2019 to monitor the use and reliability of the handpumps by recording hourly water volume abstracted. Data from April 2019 to October 2021 for 26 of these sites, alongside qualitative data, were analysed and each handpump's contribution to year-round water security was explored, focusing on the long dry season when water supply from other sources is compromised. Abstraction was over 20 times higher in the long dry season than in any other season, and at sites with higher salinity, higher livestock use, and larger dam wall area. At 21 wells, abstraction was still being recorded at the end of at least one long dry season; however, high spatial and temporal heterogeneity between pumps and seasons means that not all sand dams deliver reliable water supply year-round. Quantifying the contribution that sand dams make to water security is crucial for understanding their resilience against a changing climate and can aid decision makers when choosing the most appropriate water management technique. Knowledge of temporal and site heterogeneity in abstraction can inform when other water sources need increasing and can help with sand dam design optimisation. Overall, our results indicate the positive contribution that sand dams make to year-round water security through the water that is abstracted through handpumps.

The Association Between Rainfall, Temperature, and Reported Drinking Water Source: A Multi-Country Analysis

Climate change may alter access to safe drinking water, with important implications for health. We assessed the relationship between temperature and rainfall and utilization of basic drinking water (BDW) in The Gambia, Mozambique, Pakistan, and Kenya. The outcomes of interest were (a) whether the reported drinking water source used in the past 2 weeks met the World Health Organization definition of BDW and (b) use of a BDW source that was always available. Temperature and precipitation data were compiled from weather stations and satellite data and summarized to account for long- and short-term weather patterns and lags. We utilized random forests and logistic regression to identify key weather variables that predicted outcomes by site and the association between important weather variables and BDW use. Higher temperatures were associated with decreased BDW use at three of four sites and decreased use of BDW that is always available at all four sites. Increasing rainfall, both in the long- and short-term, was associated with increased BDW use in three sites. We found evidence for interactions between household wealth and weather variables at two sites, suggesting lower wealth populations may be more sensitive to weather-driven changes in water access. Changes in temperature and precipitation can alter safe water use in low-resource settings-investigating drivers for these relationships can inform efforts to build climate resilience.

A decision support tool to place drinking water sources in rural communities

Installing more drinking water sources is a promising way to achieve the 6th sustainable development goal "Clean water and sanitation" in rural communities. A key parameter for the installation of new water pumps is geographical position, because the number of people who could gain access to drinking water depends on the location of the pump. To improve the choice of the most appropriate location, we propose a decision support tool to place a new drinking water source in a rural community. This tool relies on four complementary maps, which are obtained from GPS data, survey data, and a water source choice model. The first map shows the spatial distribution of the households and of the existing water sources in the village. The three remaining maps present the following quantities as a function of the position of a new drinking water source in the village: the number of users of the new drinking water source, the improvement of drinking water access, and the daily water demand per capita at the new drinking water source. The decision support tool is applied to a village in Burkina Faso. Results indicate that using the proposed method could allow eight times more people to gain access to drinking water in comparison to a random positioning of the new drinking water source. The original contribution of this work is, first, the consideration of existing water sources in the village, as well as seasonality. Second, we base our analysis on a water source choice model, which accounts for water quality in addition to the distance to the water source. Third, we consider the variability of the water volume collected by the households throughout the village. The developed tool is generic, transferable to other villages and useful for various decision-making entities (e.g. local authorities and non-governmental organizations).

Review of Community-Managed Water Supply—Factors Affecting Its Long-Term Sustainability

Although water is considered a human right, rural communities in many countries face challenges related to the lack of a safe water supply. In rural areas, where there is no access to public or private water supply, populations have no other choice than to rely on other unsafe sources of water. Community-managed water supply (CMWS) has emerged as an alternative to address the lack of access to safe water. Nonetheless, this alternative has several critical characteristics that harm the sustainability of water supplies. Studies on sustainability and the long-term impact of the CMWS were explored through a review of recent literature using Scopus and Web of Science databases, which analyzed 86 papers reporting on research into the sustainability and efficiency of water supply systems managed and operated by local communities, as well as the long-term critical factors that can interfere with the functionality of these systems. Based on the critical factors most cited in the literature, we proposed a framework of strategies that interrelate and integrate the critical factors into levels of responsibility. The most critical factors are related to the community level, such as inadequate capacity and ineffective systems. This demonstrates the relevance of local characteristics in the implementation of water management systems. The most cited sustainability strategies refer to the local level as the one requiring action to promote effective community involvement and post-construction support. The framework helps to conceptualize what we called an enabling environment for decision-making, and thus, the achievement of the long-term sustainability of water supply.

Effects of seasonality on access to improved water in Benue State, Nigeria

Many people switch sources of drinking water and sanitation between seasons, yet such shifts are not reflected in the reporting of access to improved water and sanitation services by the Joint Monitoring Programme (JMP). Drawing on quantitative and qualitative data collected from urban and rural sites in dry and rainy seasons in Benue state, Nigeria, this study highlights the importance of seasonal variations in water access and quality. Water testing showed that water sources had higher levels of contamination with coliforms, nitrate and chloride in the dry season than the wet season. The contamination of water from these pollutants is above WHO standards and believed to come mainly from pit latrines. Semi-structured interviews revealed that many people who use improved water and sanitation facilities in the rainy season sometimes switch to poorer quality unimproved sources in the dry season. Travel times for collecting water as well as waiting times also significantly increased in the dry season. It is recommended that this important seasonality element is factored into JMP data collection and reporting.

How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

OBJECTIVE

To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.

DESIGN

Realist review.

DATA SOURCES

PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).

ANALYSIS

Inductive and deductive coding was used to generate context-mechanism-outcome configurations.

RESULTS

73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation.

CONCLUSIONS

The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.

Multiple water source use in low- and middle-income countries: a systematic review

The Joint Monitoring Programme (JMP) 2017 Update and Sustainable Development Goals (SDGs) Baselines report classified 71% of the global population as having access to 'safely managed' drinking water. Current global monitoring efforts to track access to safely managed drinking water rely on collecting information on the 'primary' source of drinking water. However, there is evidence that households often rely on multiple sources to meet their water needs in many low- and middle-income countries (LMICs). This systematic review was designed to compile the literature related to the practice of multiple water source use (MWSU) for drinking water in LMICs. A total of 5,318 studies were collected, and after abstract and full-text review, 74 articles were identified for inclusion. Studies reviewed reported from 4 to 100% of the study populations practicing MWSU. Additionally, the practice of supplemental unimproved source use was reported globally, representing households with improved primary source water also accessing unimproved water sources throughout the year. These findings expose gaps in current global water monitoring efforts, revealing potential inflation of reports of 'safe drinking water access' and unaccounted exposure to drinking water from unimproved sources.

A System Dynamics Model of the Community-Based Rural Drinking Water Supply Program (PAMSIMAS) in Indonesia

The sustainability of the water supply program in developing countries is influenced by many inter-linked and dynamic factors, suggesting the need to analyse the system behaviour of the water supply program. However, no study analyses factors influencing the sustainability of rural drinking water supply programs holistically, and this study aims to fill that gap. This study utilized a system dynamics approach based on a case study of a community-based rural drinking water supply program (PAMSIMAS in Bahasa) in Magelang Regency, Indonesia. Five sustainability aspects were considered in the model development and simulation: financial, institutional, environmental, technical, and social aspects. Eight scenario analyses related to those five aspects were conducted. The causal loop diagrams suggest that the overall loop in the system is reinforcing, meaning that the improvement in one aspect will improve the overall condition of the system and deterioration in one aspect will reduce the overall condition of the system. Scenario analysis shows that external fund is critical to support the program financially, especially at the beginning of the project when the piped system is being built and water revenue is still low. Scenario and sensitivity analyses revealed that human factors, i.e., the performance of the water board and response and support from the community, positively influence the sustainability of the water supply program. Additionally, the water board plays a key role in accelerating the pipe network growth. Finally, this paper argues that visualising and simulating the causal relationship and dynamic behaviour of the rural water supply program are critical for water stakeholders to better design and implement the water supply program.

Tryptophan-like fluorescence as a high-level screening tool for detecting microbial contamination in drinking water

Regular monitoring of drinking water quality is vital to identify contamination of potable water supplies. Testing for microbial contamination is important to prevent transmission of waterborne disease, but establishing and maintaining a water quality monitoring programme requires sustained labour, consumables and resources. In low resource settings such as developing countries, this can prove difficult, but measuring microbial contamination is listed as a requirement of reaching the UN's Sustainable Development Goal 6 for water and sanitation. A nine-month water quality monitoring programme was conducted in rural Malawi to assess the suitability of tryptophan-like fluorescence (TLF), an emerging method for rapidly detecting microbial contamination, as a drinking water quality monitoring tool. TLF data was compared with thermotolerant coliforms (TTCs, E. coli) and inorganic hydrochemical parameters. A large (n = 235) temporal dataset was collected from five groundwater drinking water sources, with samples collected once or twice weekly depending on the season. The results show that TLF can indicate a broader contamination risk but is not as sensitive to short term variability when compared to other faecal indicators. This is likely due to a broad association of TLF with elevated DOC concentrations from a range of different sources. Elevated TLF may indicate preferential conditions for the persistence of TTCs and/or E. coli, but not necessarily a public health risk from microbial contamination. TLF is therefore a more precautionary risk indicator than microbial culturing techniques and could prove useful as a high-level screening tool for initial risk assessment. For widespread use of TLF to be successful, standardisation of TLF values associated with different levels of risk is required, however, this study highlights the difficulties of equating TLF thresholds to TTCs or E. coli data because of the influence of DOC/HLF on the TLF signal.

Seasonality of drinking water sources and the impact of drinking water source on enteric infections among children in Limpopo, South Africa

Enteric infections and water-related illnesses are more frequent during times of relative water abundance, especially in regions that experience bimodal rainfall patterns. However, it is unclear how seasonal changes in water availability and drinking water source types affect enteric infections in young children. This study investigated seasonal shifts in primary drinking water source type and the effect of water source type on enteric pathogen prevalence in stool samples from 404 children below age 5 in rural communities in Limpopo Province, South Africa. From wet to dry season, 4.6% (n = 16) of households switched from a source with a higher risk of contamination to a source with lower risk, with the majority switching to municipal water during the dry season. In contrast, 2.6% (n = 9) of households switched from a source with a lower risk of contamination to a source with higher risk. 74.5% (n = 301) of the total households experienced interruptions in their water supply, regardless of source type. There were no significant differences in enteric pathogen prevalence between drinking water sources. Intermittent municipal water distribution and household water use and storage practices may have a larger impact on enteric infections than water source type. The limited differences in enteric pathogen prevalence in children by water source could also be due to other exposure pathways in addition to drinking water, for example through direct contact and food-borne transmission.

Coping with water insecurity at the household level: A synthesis of qualitative evidence

Water insecurity is a key public health and developmental challenge for many communities across the world. Using a meta-ethnographic synthesis, this study examines how households cope with water insecurity, as well as the socio-economic consequences and determinants of water insecurity coping strategies. A systematized keyword search was conducted in various electronic databases (PubMed, CINAHL EBSCOHost, Embase Ovid, Science Direct, Medline, Global Health, SCOPUS, Google and Google scholar). Out of 1352 potential articles, 21 studies were selected for review. Households employed nine key coping strategies. These strategies include water storage, construction of alternative water source, water sharing and borrowing from social networks, buying water from private vendors, water management and reuse, illegal connections to public water networks, water harvesting, fetching water from distant sources, and water treatment to improve the quality. Some of these coping strategies had far-reaching health and economic consequences, including the risk of water contamination, adverse psychosocial health, and impacts on household savings. We found that poor households, due to their over-reliance on short term labour-intensive and time-consuming coping strategies, are further economically disadvantaged by water insecurity. From a policy perspective, we recommend that investments in effective and efficient water supply infrastructure are needed to help alleviate the day-to-day hassles of water users. While policymakers are looking for long term solutions to these problems, some of the coping strategies identified in this synthesis, such as water conservation, water reuse, and purification of water before consumption, could be encouraged as supplementary strategies to meet households' immediate water needs.

Climate adaptation for rural water and sanitation systems in the Solomon Islands: A community scale systems model for decision support

Delivering water and sanitation services are challenging in data poor rural settings in developing countries. In this paper we develop a Bayesian Belief Network model that supports decision making to increase the availability of safe drinking water in five flood-prone rural communities in the Solomon Islands. We collected quantitative household survey data and qualitative cultural and environmental knowledge through community focus group discussions. We combined these data to develop our model, which simulates the state of eight water sources and ten sanitation types and how they are affected by season and extreme events. We identify how climate and current practices can threaten the availability of drinking water for remote communities. Modelling of climate and intervention scenarios indicate that water security could be best enhanced through increased rainwater harvesting (assuming proper installation and maintenance). These findings highlight how a systems model can identify links between and improve understanding of water and sanitation, community behaviour, and the impacts of extreme events. The resultant BBN provides a tool for decision support to enhance opportunities for climate resilient water and sanitation service provision.

Reflecting SDG 6.1 in Rural Water Supply Tariffs: Considering ‘Affordability’ Versus ‘Operations and Maintenance Costs’ in Malawi

Local tariffs in the form of household contributions are the primary financial mechanism to fund the maintenance of rural water supplies in Malawi. An investigation was conducted into the tariffs set by rural service providers to sustain drilled boreholes equipped with Afridev handpumps. A binary logistic regression analysis identified significant explanatory variables for the most common identified considerations when setting tariffs, ‘affordability’ and ‘operations and maintenance (O&M) costs’. The results demonstrate tariffs collected less frequently and usage above the design limit of the Afridev (300 users) had lower odds of considering affordability and higher odds of considering O&M costs, than those collected per month and within the design limit. The results further suggest a recognition by service providers of an increased maintenance challenge. High usage, acquiring spare parts, and the collection of tariffs when repairs are required indicate an increased likelihood of considering O&M costs, conversely to considering affordability. The balance of affordability and sustainable maintenance is a perpetual challenge under decentralised service delivery. Investment into ongoing support and supply chains is required for the financial and operational requirements of water supply, to ensure payments for services does not prevent access to clean water at the local level and to achieve the 2030 agenda.

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.

Water Source Preferences and Water Quality Perceptions among Women in the Eastern Region, Ghana: A Grounded Theory Study

Residents in the Eastern Region, Ghana with access to improved water sources (e.g., boreholes and covered wells) often choose to collect water from unimproved sources (e.g., rivers and uncovered wells). To assess why, we conducted two field studies to coincide with Ghana’s rainy and dry seasons. During the rainy season, we conducted semi-structured in-depth interviews among a convenience sample of 26 women in four rural communities (including one woman in the dry season). We asked each participant about their attitudes and perceptions of water sources. During the dry season, we observed four women for ≤4 days each to provide context for water collection and water source choice. We used a grounded theory approach considering the multiple household water sources and uses approach to identify three themes informing water source choice: collection of and access to water, water quality perception, and the dynamic interaction of these. Women selected water sources based on multiple factors, including season, accessibility, religious/spiritual messaging, community messaging (e.g., health risks), and ease-of-use (e.g., physical burden). Gender and power dynamics created structural barriers that affected the use of unimproved water sources. A larger role for women in water management and supply decision-making could advance population health goals.

Improved Drought Resilience Through Continuous Water Service Monitoring and Specialized Institutions—A Longitudinal Analysis of Water Service Delivery Across Motorized Boreholes in Northern Kenya

Increasing frequency and severity of drought is driving increased use of groundwater resources in arid regions of Northern Kenya, where approximately 2.5 million people depend on groundwater for personal use, livestock, and limited irrigation. As part of a broader effort to provide more sustainable water, sanitation, and hygiene services in the region, we have collected data related to site functionality and use for approximately 120 motorized boreholes across five counties. Using a multilevel model to account for geospatial and temporal clustering, we found that borehole sites, which counties had identified as strategic assets during drought, ran on average about 1.31 h less per day compared to non-strategic borehole sites. As this finding was contrary to our hypothesis that strategic boreholes would exhibit greater use on average compared to non-strategic boreholes, we consider possible explanations for this discrepancy. We also use a coupled human and natural systems framework to explore how policies and program activities in a complex system depend on consistent and reliable feedback mechanisms. Funding was provided by the United States Agency for International Development. The views expressed in this article do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

Factors Associated with Water Service Continuity for the Rural Populations of Bangladesh, Pakistan, Ethiopia, and Mozambique

Access to continuous water supply is key for improving health and economic outcomes in rural areas of low- and middle-income countries, but the factors associated with continuous water access in these areas have not been well-characterized. We surveyed 4786 households for evidence of technical, financial, institutional, social, and environmental predictors of rural water service continuity (WSC), defined as the percentage of the year that water is available from a source. Multiple imputed fractional logistic regression models that account for the survey design were used to assess operational risks to WSC for piped supply, tube wells, boreholes, springs, dug wells, and surface water for the rural populations of Bangladesh, Pakistan, Ethiopia, and Mozambique. Multivariable regressions indicate that households using multiple water sources were associated with lower WSC in Bangladesh, Pakistan, and Mozambique. However, the possibility must be considered that households may use more than one water source because services are intermittent. Water scarcity and drought were largely unassociated with WSC, suggesting that service interruptions may not be primarily due to physical water resource constraints. Consistent findings across countries may have broader relevance for meeting established targets for service availability as well as human health.

Understanding the Functionality and Burden on Decentralised Rural Water Supply: Influence of Millennium Development Goal 7c Coverage Targets

The sustainability of rural groundwater supply infrastructure, primarily boreholes fitted with hand pumps, remains a challenge. This study evaluates whether coverage targets set out within the Millennium Development Goals (MDG) inadvertently increased the challenge to sustainably manage water supply infrastructure. Furthermore, the drive towards decentralised service delivery contributes to the financial burden of water supply assets. A sample size of 14,943 Afridev hand pump boreholes was extracted from a comprehensive live data set of 68,984 water points across Malawi to investigate the sustainability burden as emphasis shifts to the 2030 agenda. The results demonstrate that the push for coverage within the MDG era has impacted the sustainability of assets. A lack of proactive approaches towards major repairs and sub-standard borehole construction alongside aging infrastructure contributes to reduced functionality of decentralised supplies. Furthermore, costly rehabilitation is required to bring assets to operational standards, in which external support is commonly relied upon. Acceleration towards the coverage targets has contributed towards unsustainable infrastructure that has further implications moving forward. These findings support the need for Sustainable Development Goals (SDG) investment planning to move from a focus on coverage targets to a focus on quality infrastructure and proactive monitoring approaches to reduce the future burden placed on communities.

Infrastructure is a necessary but insufficient condition to eliminate inequalities in access to water: Research of a rural community intervention in Northeast Brazil

Given the importance of reducing diverse forms of inequality in access to water, highlighted both in the framework of the Human Right to Water (HRW) and in the Sustainable Development Goals (SDG), this work assesses conditions of access to water and related inequalities before and after the construction of a Water Supply System (WSS) in a rural community of Brazil's semi-arid region. A quasi-experimental study was performed to assess the conditions of access to water for study and control groups (amounting to 380 households). The methodology encompassed two phases, one prior and another subsequent to the construction of a WSS in the study community. The analytical framework of the HRW was applied, specifically the normative content regarding quality, accessibility and availability. The case study's findings help to evidence the limitations and challenges of merely infrastructure-related measures to improve access to water. The construction of a new WSS in the studied community was an improvement as it provided water of good quality to the beneficiary households, which entailed a decreased or even a no-longer-existing need to collect water for children and adolescents. However, certain problems persisted, such as the continued practice of collecting water and the use, by certain families, of water that was fecally contaminated. In a different perspective, the WSS made it possible to increase the per capita volume of water consumed by families and to reduce inequalities associated with this aspect. Meanwhile, the research reveals the possible limits of the WSS in ensuring that higher volumes of water will be consumed per capita, especially among households without intra-household water distribution infrastructure.

Rainfall and groundwater use in rural Kenya

This study examines the relationship between rainfall and groundwater use in rural Kenya, using automatically-transmitted hourly data from handpumps (n = 266), daily rainfall records (n = 19), and household survey data (n = 2508). We demonstrate a 34% reduction in groundwater use during the wet season compared to the dry season, suggesting a large shift from improved to unimproved sources in the wet season. By cross-correlating handpump and rainfall time series, we also reveal substantial short-term changes in groundwater pumping observed immediately following heavy rainfall. Further investigation and modelling of this response reveals a 68% reduction in pump use on the day immediately following heavy rain. We then investigate reasons for this behavioural response to rainfall, using survey data to examine the characteristics, concerns and behaviours of households in the area where the reduction in pump use was most marked. In this area rainwater harvesting was widespread and only 6% of households reported handpumps as their sole source of drinking water in the wet season, compared to 86% in the dry season. These findings shed light on the impact increasing rainfall variability may have on the Sustainable Development Goal of "universal and equitable access to safe and affordable drinking water for all". Specifically, we suggest a flaw in the water policy assumption that the provision of improved sources of drinking water-in this case community handpumps-translates to consistent use and the associated health benefits. We note that failure to understand and account for actual water use behaviour may results in adverse public health outcomes and maladapted WASH policy and interventions.

Effects of Community Perceptions and Institutional Capacity on Smallholder Farmers’ Responses to Water Scarcity: Evidence from Arid Northwestern China

Community contextual factors including community perceptions and institutional capacity are among the key determinants in community-based water resource management. The Institutional Analysis and Development (IAD) framework proposed by Ostrom is commonly employed to examine the outcome of common-pool resource management including water resources. However, community perceptions typically examined in behavioral economics and comparative community analysis literature are rarely incorporated in institutional analysis studies. This study draws on the IAD framework to investigate smallholder farmer communities’ responses to water scarcity in arid northwestern China. Adopting alternating multiple regression and multivariate regression models, this study conducts an empirical analysis using farmer survey data. The results show that the perceptions of water scarcity promote community actions in coping with water shortage. The perception of production risks encourages overall community responses, as well as farming- and irrigation-related responses. Communities with a stronger institutional enforcement are more responsive in taking farming-, irrigation-, and infrastructure-related actions, as well as having better overall responses. The analysis also shows that community interactional capacities and socio-economic factors may influence community actions to mitigate and adapt to adverse effects of local water scarcity. Our findings provide insights for understanding social and institutional aspects of rural farming communities toward sustainable response decisions to overcome water scarcity challenges.

Improving Monitoring and Water Point Functionality in Rural Ethiopia

This study examines the patterns, trends, and factors associated with functional community water points in rural Ethiopia and identifies potential areas of improvement in terms of practitioner response to functionality and functionality monitoring. It was part of an integrated WaSH and nutrition program implemented by UNICEF Ethiopia and the Government of Ethiopia. Cross-sectional surveys were conducted to collect WaSH-related data in communities and WaSH committees from four community-based nutrition (CBN) program groupings in Ethiopia. In all areas, CBN was implemented, but only in less than half of the areas, a WaSH intervention was implemented. Seventy-three representative kebeles, comprising 30 intervention and 43 control communities, were surveyed. Two structured surveys were conducted. The ‘community survey’ addressed community water points and their functionality and the main areas for improvement needed. The ‘WaSH committee survey’ investigated technical and management aspects of water points and their functionality. Data were analyzed using bivariate regression to identify community characteristics and management practices associated with functionality of water points and explore opportunities to improve water point functionality and monitoring. In the communities, 65% of water points were functional. Eighty percent of communities had a WaSH committee. The WaSH committee members reported that the most used water point types were protected dug wells and boreholes, and that 80% of their water points were functional. India Mark II pumps were more likely to be functional and communities with longer established WaSH committees had higher water point functionality. Communities suggested that the key factors for water point sustainability were improving water quality and water pressure, reducing water collection time, and speeding up repair times. Taking community leaders’ ‘priority lists’ into consideration offers sustainable opportunities for demand-driven, adaptive and targeted design and implementation of rural water supply programs, which, if they include the grassroots level as key informants and actors of change, can succeed. Interventions should integrate the ‘voice’ of the community, the WaSH committees, and other stakeholders and thereby facilitate transdisciplinary approaches at different stages of program management (planning, monitoring, and evaluation). This would help closing the knowledge to action gap and improve policy, programming, practice, and service delivery.

Health Risk Perceptions Are Associated with Domestic Use of Basic Water and Sanitation Services-Evidence from Rural Ethiopia

We examine factors associated with the use of basic water supply and sanitation services as part of an integrated community-based nutrition programme which included a drinking water, sanitation and hygiene (WaSH) intervention and emphasise findings related to health risk perceptions. Data were collected from 2658 households in four regions in Ethiopia with a cross-sectional survey in WaSH intervention areas, as well as in control areas, where the intervention was not implemented. The data were analysed using bivariate and multivariable regression analysis. Awareness of health risk factors related to inadequate WaSH was high in the programme area. The use of basic water and sanitation services was associated with several health risk perceptions: Perceiving water quality as good increased the odds of using basic water services as opposed to believing the water quality was poor (OR 3.94; CI 3.06–5.08; p ≤ 0.001). Believing that drinking unsafe water was the main cause for diarrhoea increased the odds of using basic water services (OR 1.48; CI 1.20–1.81; p ≤ 0.001). In the WaSH intervention group, the use of basic sanitation was more likely than in the control group. The use of basic sanitation was associated with households who had previously received sanitation training, as opposed to such who had not (OR 1.55; CI 1.22–1.97; p ≤ 0.001). Perceiving dirty space as the main cause of diarrhoea (OR 1.81; CI 1.50–2.19; p ≤ 0.001), and privacy when using a latrine (OR 2.00; CI 1.67–2.40; p ≤ 0.001), were associated with higher odds of using basic sanitation. Households that indicated a disadvantage of owning a latrine was maintenance costs were less likely to use basic sanitation (OR 0.49; CI 0.38–0.63; p ≤ 0.001). Risk perceptions were important determinants of use of basic services. The findings point to risk perceptions motivating the application of positive WaSH-related and health-protective behaviours. This suggests that well-designed health risk communication strategies may be effective for engaging households in healthy WaSH behaviour.