External support programs to improve rural drinking water service sustainability: a systematic review

This is a guest blog by Meghan Miller. Meghan is completing her PhD in the Department of Environmental Sciences and Engineering at the University of North Carolina at Chapel Hill and has conducted both her masters and doctorate research through The Water Institute.

The Water Institute recently published a systematic review on external support programs (ESPs) that target rural, often community-managed water systems. ESPs are of vital importance to long-term functionality and sustainability of rural drinking water service, as all water systems fail eventually and rural water committees can lack the resources and/or capacity to rehabilitate the systems independently.

The purpose of the systematic review was to determine how ESPs in low-, medium- and high-income countries are described and measured. The aims of the analysis were to: create a typology of ESP activities based on ESPs for rural drinking water systems; identify barriers to ESP access and implementation; and determine how ESPs effect the sustainability of rural water systems.

So what do external support programs do?

The types of ESP activities described in the literature were: technical assistance, financial assistance, monitoring and regulation, communication and coordination, administrative assistance, capacity-building, and creation of policies and enforcement of regulations. Technical assistance, financial assistance, and capacity-building were described in the majority of publications included (66%, 57%, and 53% respectively).

Need for a typology of activities and precise language

The language used to describe ESPs was not consistent between publications about low-, middle-, and high-income countries. When ESP activities go underreported, knowledge transfer is limited and support for ESPs is reduced. Communication and coordination between ESP providers is further limited by inconsistent and imprecise language. We identified twenty-one terms that were used to describe ESPs. Some terms imply that support occurs at specific phases or with specific actors. Post-construction support, for example, assumes that projects have a single construction event. The terminology should reflect how and when support is provided. The better ESP terminology is defined, the better we can compare ESPs in different settings.

External support was the most commonly used term (27% of publications) and we propose using the term “external support programs” to describe the continued support for water systems. Based on our analysis we propose the following definition for ESPs: “the set of activities provided by NGOs, government, private and community-based entities to community-member managers to ensure continued safe operation of a drinking water system.”

What are the barriers to external support programs?

Barriers to ESPs were grouped into six categories: inadequate resources, inadequate ESP support, restrictive policies, lack of communication and coordination, little access to ESPs, and insufficient training of water system managers. The barriers to ESP varied by country income classification. Lack of communication within ESPs and between ESPs and stakeholders was most frequently mentioned in publications about high-income countries (36% of the publications); lack of communicate was often characterized by unclear roles and responsibilities, lack of trust between ESPs and stakeholders, inability to resolve disputes and misunderstanding of local context. Insufficient training of staff and insufficient resources for ESP wa identified as the most common barriers to ESP in publications about low and lower-income countries (57% and 45% of publications respectively).

Little comprehensive monitoring and assessment of ESPs

Twenty studies evaluated the effects of ESPs on water service levels. Most publications described ESP activities but did not undertake data collection to assess the programs. Without a rigorous assessment of ESPs, it is difficult to identify the most effective components of ESPs. Proper monitoring requires that stakeholders understand the activities and models implemented by ESP providers. Presence of ESPs and access to spare parts were used as the indicators of ESP activity by studies assessing the effect of ESPs on households and water systems. Better monitoring would include indicators that measure the six types of ESP activities, such as the frequency and attendance rate of water committee training events. Indicators should also measure the effectiveness of different providers – these outcome indicators should be developed according to the type and purpose of the ESP. Additional assessments of ESPs will help stakeholders identify which ESP activities and models promote sustainability. Support programs can then incorporate those that promote sustainability.

Majority of publications report on ESPs for point sources

The majority of publications addressed ESPs for point sources. The focus on point sources ignores water sources in community institutions and the implementation of more complex water systems. Community institutions, such as schools and health care facilities, have different water use characteristics and management structures than community drinking water systems and support to these community institutions will require adaptations to existing ESPs. Piped water systems, compared to point sources, are more complex, have larger one-time repair costs, typically require repairs more frequently, may require specialist technicians, and may require more expensive parts. Descriptions of ESPs in community settings and for more complex systems will improve knowledge about how ESPs for can be adapted to better serve community needs.

Further reading

The full article is available as:

Miller, M., Cronk, R., Klug, T., Kelly, E.R., Behnke, N., Bartram, J., 2019. External support programs to improve rural drinking water service sustainability: A systematic review. Sci. Total Environ. 670, 717–731. https://doi.org/10.1016/j.scitotenv.2019.03.069

Figure: Model of the variables that affect and are affected by external support programs based on data from quantitative and qualitative evaluations of external support programs and review of the literature. Plus signs represent a positive relationship and negative signs represent a negative relationship. The dashed lines represent relationships that have been identified in the literature, but were not assessed in the ESP evaluations. Credit: Authors.





Rural Water Supply Research: September 2015

Research and knowledge is critical to improving rural water services worldwide. At RWSN we act as bridge between research, policy and practice.  In recent RWSN newsletters, we have collated the latest in academic research. We have moved that list here to make it more accessible (and the newsletter shorter!).  If we have missed anything, then please do let us know.

Note that access to many papers is restricted and has to be purchased. Some are open access so that articles are free to download.


Continue reading “Rural Water Supply Research: September 2015”