Abstract
Ensuring universal access to safe drinking water is a global challenge, especially in rural areas. This research aimed to assess the effectiveness of a risk-based strategy to improve drinking water safety for five gravity-fed piped schemes in rural communities of the Mid-Western Region of Nepal. The strategy was based on establishing community-led monitoring of the microbial water quality and the sanitary status of the schemes. The interventions examined included field-robust laboratories, centralized data management, targeted infrastructure improvements, household hygiene and filter promotion, and community training. The results indicate a statistically significant improvement in the microbial water quality eight months after intervention implementation, with the share of taps and household stored water containers meeting the international guidelines increasing from 7% to 50% and from 17% to 53%, respectively. At the study endline, all taps had a concentration of <10 CFU Escherichia coli/100 mL. These water quality improvements were driven by scheme-level chlorination, improved hygiene behavior, and the universal uptake of household water treatment. Sanitary inspection tools did not predict microbial water quality and, alone, are not sufficient for decision making. Implementation of this risk-based water safety strategy in remote rural communities can support efforts towards achieving universal water safety.
Highlights
In recent years, water sector professionals have made considerable progress improving access to drinking water worldwide
This study revealed the limitations of sanitary inspection scores and concluded that such tools should be combined with regular water quality testing for a complete risk management approach
The aims of this research were to describe an approach for improving the drinking water safety that is adapted to this unique setting, as well as to rigorously evaluate whether this strategy was capable of achieving measurable improvements in the water quality
Summary
Water sector professionals have made considerable progress improving access to drinking water worldwide. The MDGs underscored an urgent need to prioritize interventions designed to limit the hazards to human health by meeting the international guidelines for drinking water safety [5]. To address this issue, the water sector adopted Sustainable Development Goal (SDG) 6, which includes measures of availability, accessibility, and quality as core standards in its definition of safely managed drinking water [6]. The water sector adopted Sustainable Development Goal (SDG) 6, which includes measures of availability, accessibility, and quality as core standards in its definition of safely managed drinking water [6] With these considerations, over a quarter of the global population currently lacks access to safely managed drinking water [7]. Public Health 2018, 15, 1616; doi:10.3390/ijerph15081616 www.mdpi.com/journal/ijerph
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