It is increasingly acknowledged that high income countries do not enjoy universal drinking water coverage, with pockets of water insecurity persisting close to areas that have had high-quality, centralized water provision for half a century or more. The reasons behind this are complex, and effective ways to improve water security in these areas defy simple prescriptions. Nuanced measures that disaggregate the different facets of water insecurity are especially important as we attempt to understand and, crucially, improve water security in high-income countries. In this paper, we describe a qualitative protocol for assessing water insecurity at the household level in a study conducted in rural and unincorporated settlements in the Southwestern United States. The study focuses on households connected to small, piped water systems; households that rely on hauled water, individual wells, and other sources; and those who are withdrawing from centralized systems. The goals of this study are: 1) to measure a baseline for individual households' water security; 2) identify mechanisms for coping with poor water insecurity; 3) evaluate changes in water insecurity following co-designed interventions. We include in this protocol three codebooks for the coding and analysis of interview data, to make them available for use by other water insecurity researchers. The design embeds the interventions into the study without pre-supposing the nature of the interventions. The socio-technical interventions will be co-designed by the study team, project partners, and the communities themselves. By identifying and working with communities experiencing different water insecurity challenges the study aims to directly increase their water security and develop a deeper understanding of the drivers of and responses to water insecurity in the Southwestern United States.

Despite nationally reported metrics that suggest high levels of water security, approximately 12% of the United States of America (US) population is estimated to be water insecure based on the definition in United Nations (UN) SDG 6.1.1. Approximately half of these households are served by Decentralized Water Systems (DWS). In contrast, most research, engineering, innovation, and government programs are focused on Centralized Water Systems (CWS). In this perspective, we 1) characterize and define DWS using professional language common for CWS; 2) compare the social, economic, and regulatory responsibilities of stakeholders in each system; 3) outline existing strategies to professionalize this sector; and 4) propose research avenues to further professionalize DWS to ensure households served by these systems receive equitable water service. We demonstrate that while DWS share commonalities with CWS, decentralized systems are less formally structured; have more stakeholders between source and tap; and place much of the regulatory, finance, maintenance, and safety responsibilities on individual households. These responsibilities include ensuring water quantity and quality, selecting appropriate treatment technologies, finance of repairs and upgrades, and transporting water. We propose strategies for researchers to aid in codeveloping innovative DWS solutions, ensuring relevant integration and community-driven models that better support decentralized communities.

Water supply interruptions contribute to household water insecurity. Unpredictable interruptions may particularly exacerbate water insecurity, as uncertainty limits households' ability to optimize water collection and storage or to modify other coping behaviors. This study used regression models of survey data from 2873 households across 10 sites in 9 middle-income countries to assess whether water supply interruptions and the predictability of interruptions were related to composite indicators of stressful behaviors and emotional distress. More frequent water service interruptions were associated with more frequent emotional distress (β = 0.49, SE = 0.05, P < 0.001) and stressful behaviors (β = 0.39, SE = 0.06, P < 0.001). Among households that experienced interruptions, predictability mitigated these respective relationships by approximately 25 and 50%. Where the provision of continuous water supplies is challenged by climate change, population growth, and poor management, water service providers may be able to mitigate some psychosocial consequences of intermittency through scheduled intermittency and communication about water supply interruptions. Service providers unable to supply continuous water should optimize intermittent water delivery to reduce negative impacts on users, and global monitoring regimes should account for intermittency and predictability in post-2030 water service metrics to better reflect household water insecurity experiences.

ABSTRACT Multiple‐use water services (MUS) encompass a variety of water services that span the various livelihood strategies commonly seen in communities throughout low‐ and middle‐income countries. MUS approaches can secure water for development, but limited peer‐reviewed research comprehensively evaluates MUS. This review addresses a gap in the literature by tracing MUS as an international development strategy and evaluating the peer‐reviewed scholarship published between 1990 and 2023 to describe the status and trends. The review identifies MUS attributes (e.g., water productivity, economics, health and nutrition, and gender empowerment) and the persistent barriers to scaling and institutionalization (e.g., regulatory and governance barriers and water quality). It then concludes with gaps in research (e.g., private sector roles and business models, ability to pay, ecosystem services, and climate resilience). MUS has the potential to be implemented tactically to address the nexus of water, food, nutrition, and water quality challenges, if research can contribute to evidence for scalable solutions that sufficiently address local needs.

FundiFix is a social enterprise that offers rural water systems maintenance service in rural Kenya. In recent years FundiFix has been operating these three types of water system that fall under the MAD (modular, adaptive, and decentralised) water systems paradigm: Solar powered groundwater kiosks, water ATMs, and reverse osmosis filtrations systems. This article outlines some of the challenges of operating these in a rural context. We identify four key challenges that must be considered if these technologies are to provide sustainable benefits to rural communities: managing higher capital and maintenance costs; the requirement for more skilled staff to manage and maintain them; the risk of the most marginalised communities being left behind; the importance of considering maintenance from the start.

Rainy seasons across rural sub-Saharan Africa see a dramatic reduction in the collection of groundwater from water points, exposing communities to health risks and reducing the sustainability of service providers. Kenyan water service provider FundiFix operates water points in dispersed rural communities in semi-arid Kitui County. It observes 5 to 10 times less water collected and revenues close to zero during rainy seasons. Water ATMs record precise volumes of water dispensed and allow for timely price changes. It was hypothesised that reducing the price from 3 to 1 KES per jerrycan would cheaply maintain clean water collection and possibly increase revenue. FundiFix tested this intervention over the March-April-May 2023 rainy season at three water ATM piped schemes and communicated the price reduction to users, with a fourth control unchanged. This did little to nothing to maintain the collection of water at dry season levels. This shows other practitioners that to address the seasonality challenge, price reductions need to be combined with a deeper understanding of user behaviour, which requires further study. This study only cost 100 USD in lost revenue from the reduced price. Implications for practitioners are outlined. Conditional transfers of water credit to users, rather than price reductions, are discussed.

Despite decades of effort, progress in safely managed sanitation-a public sector mandate-is stalling due to limited public funding and poor governance, among other reasons. As a result, public health has suffered and environmental degradation has continued. Social enterprises that use innovative business models to provide on-site sanitation services, also known as sanitation enterprises, are considered an emerging solution. However, sanitation enterprises have not yet successfully replaced public provision at scale. This work explores the barriers that sanitation enterprises encounter in lower- and middle-income countries. Q-Method, a mixed-methods approach that assesses social perspectives on an issue, is used to evaluate major barriers and groups of dominant perception for 19 sanitation enterprises operating across 20 countries. A total of 25 mutually exclusive, collectively exhaustive barriers are identified, ranging from affording capital expenses to navigating political corruption. The results show that most of the identified barriers fall into the financial barrier category, with reaching economies of scale being the greatest obstacle for sanitation enterprises. On the basis of these results, the premise of independent profitability underlying the sanitation enterprise value proposition should be reevaluated. Four enterprise types are proposed and can explain half of the variance among the sanitation enterprises studied. The context of a sanitation enterprise, including its countries of operation, size, customer base, sources of revenue, and section of the sanitation value chain, influences the barriers that the enterprise encounters. This research underscores the crucial role of context in influencing barriers for sanitation enterprises, emphasizing the need for investment and for policy makers to take these contextual dimensions into account.

BackgroundHandpumps are used by millions of people as their main source of water. Although handpumps represent only a basic form of water provision, there have been continuous efforts to improve the performance of these systems as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90% of handpump faults repaired within 3 days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. However, it is not clear if operational improvements lead to health gains. Despite limited empirical evidence, some modeling studies suggest that even short periods of drinking contaminated water can lead to disproportionate negative health impacts. ObjectiveThe aim of this study was to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes. MethodsFrom a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured the 2-week prevalence of World Health Organization–defined diarrhea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households’ handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socioeconomic characteristics; dwelling construction; and Water, Sanitation, and Hygiene (WASH)-related factors. We fitted an additional model to examine select interactions between covariates. ResultsReported diarrhea in children was lower in households whose pumps had been repaired within 24 hours (adjusted odds ratio 0.35, 95% CI 0.24-0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pump repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhea in conjunction with socioeconomic improvements. ConclusionsOnly pump repairs consistently made within 24 hours of failure led to a reduction in diarrhea in the children of families using handpumps. While the efficacy of reduction in diarrhea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts.

Centralized water infrastructure has, over the last century, brought safe and reliable drinking water to much of the world. But climate change, combined with aging and underfunding, is increasingly testing the limits of-and reversing gains made by-these large-scale water systems. To address these growing strains and gaps, we must assess and advance alternatives to centralized water provision and sanitation. The water literature is rife with examples of systems that are neither centralized nor networked, but still meet water needs of local communities in important ways, including: informal and hybrid water systems, decentralized water provision, community-based water management, small drinking water systems, point-of-use treatment, small-scale water vendors, and packaged water. Our work builds on these literatures by proposing a convergence approach that can integrate and explore the benefits and challenges of modular, adaptive, and decentralized ("MAD") water provision and sanitation, often foregrounding important advances in engineering technology. We further provide frameworks to evaluate justice, economic feasibility, governance, human health, and environmental sustainability as key parameters of MAD water system performance.

Handpumps are used by millions of people as their main source of water. While only being a basic form of water provision efforts to improve the performance of these systems continue as these pumps are likely to remain in use for many years to come. One of the drivers behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. To assess whether improvements in operational performance from the data-driven professional maintenance of rural handpumps operating in southern Kenya lead to improved household health outcomes. From a sample of households that used handpumps as their primary water source in Kwale County in Kenya, we measured two-week period prevalence of WHO-defined diarrhoea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which handpumps were professionally and relatively rapidly repaired. We then conducted a cross-sectional analysis adjusting for household socio-economic characteristics, dwelling construction and WASH-related factors. Reported diarrhoea in children was lower in households whose pumps had been repaired within 24 hours (AOR 0.35, 95% CI 0.24 to 0.51). This effect remains robust under multiple logistic regression models. No reduction was seen in households whose pumps had longer downtimes. Analysis of interaction terms showed that socio-economic and other factors combined non-linearly to reduce reported diarrhoea. Only pump repairs consistently made within 24 hrs of failure led to a reduction in diarrhoea in the children of families using handpumps. While the efficacy of reduction in diarrhoea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhoea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts.

Climate change, ageing infrastructure, and funding shortfalls threaten the sustainability of modern, 20th century centralised water systems by increasing drinking water costs and undermining water security, particularly for underserved populations. Modular, adaptive, and decentralised (MAD) water infrastructures can address this by using novel technologies, institutions, and practices to produce, transport, and store clean water in the absence of — or integrated alongside — existing centralised water infrastructure. Examples of MAD water systems include: next-generation ultrafiltration systems, atmospheric water capture systems, mobile water treatment stations, and innovative container-based systems. These decentralised models require a justice-oriented framework to unlock the promise of sustainable access to safe, reliable, affordable water supply for a more mobile, just, and resilient world. We propose a model for advancing justice-oriented MAD water.

In much of rural sub-Saharan Africa, households tend to shift water collection during rainfall periods away from cleaner groundwater sources, which they often have to pay for, towards free alternative sources. This increases disease risk and decreases sustainability of service provision. New approaches are needed to incentivize households to maintain clean water use and mitigate this environmental health challenge. We propose a pricing mechanism for 'water ATMs' – now possible with their pre-payment and remote monitoring capabilities – derived from measured reductions in collection over rainfall periods. Appropriate price elasticity ranges (−0.5 to −1) and relative risk of diarrhoeal disease from this intervention (0.4 to 0.8) determined from the literature are used to estimate the cost per capita and cost per disability-adjusted life year (DALY) averted. These are estimated to be between US$5 and 50 per DALY averted in the scenarios studied here, which would compare favourably against other water quality interventions. Cost and value would depend on elasticity of demand and potential health gains across different communities. Considerations for implementation are discussed. The potential for accurate subsidy transfers to service providers is outlined, along with the added resilience to climate change.

The presence of the mobile phone network in rural areas where there is little other infrastructure has opened up the prospect of automatically monitoring rural water systems, something previously possible only in person and perhaps only on foot. The technology to monitor these systems continues to develop: basic systems are now leaving research and being implemented in operational WASH programs; machine learning is making pump failure prediction possible. With the move from the previous infrastructure-focused community management paradigm, to a service-delivery approach to rural water, remote monitoring has salience with its potential to inform professional maintenance services. This is not without cost. To justify its use in rural water service delivery remote monitoring must generate benefits for service providers: (1) it must be integrated into management systems, and help redesign them; (2) it must contribute to increases in performance that produce real improvement in outcomes for water users; (3) it must open up new transparent sources of funding previously unavailable to the rural water sector. If remote monitoring can do these three things it has a role to play in achieving SDG 6.1; if not it will join the list of development techno-fixes that failed to make an impact despite the best of intentions. This article is categorized under: Human Water > Human Water

The Sustainable Development Goal of providing everyone with safe and reliable drinking water services combines a moral imperative with an entrepreneurial opportunity. We examine water user behavior in the face of institutional change brought about by a professional service provider maintaining rural water infrastructure in Kenya. We ask (1) which factors are associated with households and waterpoint user groups contracting a service provider that guarantees rapid repairs; (2) how do factors vary between different management cultures defined by cultural theory of risk; and (3) can the professional service provider address the risk factors? By applying the cultural theory of risk framework, we capture the institutional diversity of community, public, private and failed management on the ground in dealing with operational, financial, institutional and environmental risks. To identify the factors associated with institutional change towards a pluralist arrangement - enabled by the professional maintenance service provider incubated in rural Kenya - we model data from 1215 households at actively managed handpumps with sensor data from daily handpump usage and community responses to this entrepreneurial approach. The predictors of behavior change of rural water users to commit to the new service provider include organizational factors of managing payments, affordability, and operational factors such as distance and water quality, which vary in importance across the management cultures. This learning can be harnessed to reduce risk and inform future policy and practice. As professional maintenance services for rural water infrastructure are emerging across Africa, which promise to increase value for rural water users, government, and investors through performance-based contracts, it is important for policymakers and implementers to understand which factors predict shifts in institutional behavior by water users. This research recommends seeking cooperative solutions across systems, where current policy effectively separates communities from the state or markets. (C) 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license.y

Water scholarship has advanced considerably in recent decades. Despite this remarkable progress, water challenges may be growing more quickly than our capacity to solve them. While much progress has been made toward achieving Sustainable Development Goal 6 - water and sanitation for all - new stressors have emerged to threaten this progress. Far from being a problem of the Global South, recent research shows that water insecurity is very much a global phenomenon - and one that has been, until recently, seriously neglected in the Global North. This indicates a strong need for innovative measurement of who experiences water insecurity, new approaches for monitoring the efficacy of water interventions, and more effective management of complex, mobile, and multiple water infrastructures to achieve water security. In this paper, we introduce the Household Water Insecurity approach to addressing these concerns. First, we suggest ways to improve the measurement of water insecurity - pinpointing problems at the household and individual levels - in ways that can inform policymaking with improved precision. Second, we discuss ways that new information and communication technology can improve monitoring and indicate where water infrastructure repairs and investments are most needed. Third, we highlight the need for new approaches to managing complex water infrastructures in more inclusive and democratic ways.

Climate change and future abstraction regimes will influence the availability of groundwater resources. To alleviate any potential negative effects on aquifer systems and dependent industrial and human uses, it is important to develop long-term water management plans. This study evaluates the effect of climate change and future increased groundwater demand from a coastal aquifer located in Kwale County in southern Kenya. A previously calibrated numerical groundwater flow model has been used as an assessment tool to study how future climate (precipitation and temperature variation) and groundwater abstraction changes will affect the aquifer system. The groundwater flow model was built to simulate the period 2010 to 2017, and eight future model scenarios were developed that cover six hypothetical future years. Future groundwater abstraction has been based on current allocations and future estimates made by Kenya's Water Resources Authority. Future rainfall scenarios have been constructed based on a long historical data series (from 1959 to 2017) and the Standard Precipitation Index. The main results show that future abstraction increases due to economic growth exerts a minimum impact compared with expected climate variability. Recharge depends on intense rain events with important implications for both dry periods and for an average rainfall year. A succession of extended dry seasons may affect all water users. However, the groundwater level decline in the local shallow aquifer can reach five meters, with important consequences for local community water supplies. The most significant groundwater decline in drought periods is observed in the area surrounding the pumping wellfields in the deep aquifers, where the effects of drought and significant abstraction are multiplied. However, the effect of increased abstraction on the shallow aquifer system is limited. Despite groundwater level decline observed during prolonged dry periods, a dry period followed by a humid period leads to the relatively swift recovery of the groundwater system.

The links between groundwater and welfare are highly contested, unclear and confounded by political, environmental and economic factors. The lack of understanding of these links has wider implication on policies and strategies aimed at accelerating the sustainable development goals of safely-managed drinking water services and eradicating poverty. This study provides empirical evidence of the existing links between groundwater and poverty using welfare metrics versus productive uses of water, groundwater table depth, drinking water services and groundwater dependency with data obtained from a household socio-economic survey (n = 3349), a water audit of water infrastructure (n = 570) and volumetric usage from water data transmitters (n = 300). Results show that the bottom welfare households are characterized by greater dependency on shallow groundwater, less acceptable drinking water services by taste, reliability, affordability or accessibility but not quantity. Productive use of groundwater for livestock accrues to the middle welfare quintiles with the bottom and top welfare quintiles by choice or exclusion having little engagement. Groundwater productive uses, services and characteristics explain at least 17% of the variation in a households' welfare with productive uses particularly benefiting female headed households. These findings suggest that ancillary investments to improve affordability and reliability of rural water services will be needed to enhance welfare of the poor who depend on groundwater systems. Further, such knowledge of the relationships between water and welfare can support the formulation of policies and strategies aimed at poverty reduction, inclusive growth and access to safe water for all.