My research project
The review and update of sanitary inspections for small water supplies and the gauging of their impacts
According to the World Health Organization (WHO), in 2018 more than two billion people worldwide used a contaminated drinking-water source. Small water supplies (such as wells, springs etc) are often more susceptible to contamination for a number of reasons, including; reduced levels of knowledge among operators; lack of investment; and omission from drinking-water legislation.
My research topic focuses on the risk assessment of small drinking-water supplies. More specifically, my aim is to update the WHO sanitary inspection (risk assessment) forms that will be included in the soon-to-be published 3rd edition of the Guidelines for drinking-water quality - Surveillance and control of community supplies. Risk assessments can be a valuable tool for the improvement or maintenance of small drinking-water supplies as they are cheap to undertake and can be used to direct resources for remedial actions in an efficient and accurate manner. They can also take into account challenges such as climate change.
During my research I will undertake qualitative and quantitative studies in Iceland and Uganda to:
- Investigate the scientific validity of the risk assessment questions included on the sanitary inspection forms
- Determine the most appropriate water supply types to be covered by the new form
- Determine the levels of variation in risk assessment scoring due to subjective answering
- Develop a guide on how to adapt sanitary inspections to a local context
- Produce a digital sanitary inspection form for use in Iceland
- Produce training materials on how to successfully undertake a risk assessment.
Small drinking-water supplies face particular challenges in terms of their management. Being vulnerable to contamination but often not monitored regularly nor well-maintained, small drinking-water supplies may pose consequences for health of users. Sanitary inspection (SI) is a risk assessment tool to identify and manage observable conditions of the water supply technology or circumstances in the catchment area that may favour certain hazardous events and introduce hazards which may become a risk to health. This qualitative research aimed to identify the strengths and weaknesses of the SI tool as published by the World Health Organisation to inform a review and update of the forms and to improve their robustness. The study identified a number of benefits of the approach, such as its simplicity and ease of use. Challenges were also identified, such as potential for inconsistencies in perception of risk between inspectors, in interpreting questions, and lack of follow-up action. The authors recommend a revision of the existing SI forms to address the identified challenges and development of complementary advice on possible remedial action to address identified risk factors and on basic operations and maintenance.
To achieve Sustainable Development Goals (SDGs) 6, universal and equitable access to safe and affordable drinking-water quality and sanitation for all, and 10, to reduce inequality within and among countries, additional and urgent work is required. Efforts to achieve these Goals in the context of small drinking-water supplies, which are the furthest behind in regards to progress, are of particular need. Reasons for this disparity in progress include the remoteness of access to small drinking-water supplies and the lack of technical and financial capacity for monitoring supplies. The World Health Organization promote the use of Sanitary inspection (SI) as an on-site assessment of risk. Despite the potential to increase the body of knowledge and information on supplies in a region, there has been limited research into the role of citizen science and SIs. To meet SDG targets, we need to improve the reach of SIs. This study uses a mixed methods approach of quantitative on-site SI data collection and remote SI data collection via photographic images, together with qualitative data collection, collected by non-expert students, who are citizens of Malawi, as well as a panel of experts in the field of SI. Results indicate that, although further research into the topic is required prior to widescale implementation, the potential exists for citizens to conduct SI, with remote expert verification of the results using photographic images of supplies. Further documentation or guidance is required to support citizens in this process. The results highlight a critical gap in the availability of appropriate documentation for unprotected spring sources which is urgently required. The use of citizen science for SI data collection is in its infancy. However, this study indicates that there is potential to explore the use of citizen science in this area, which will contribute to achieving SDGs 6 and 10.
Water Safety Plan (WSP) implementation has the potential to greatly improve, commonly very challenging and resource limited, small drinking water supplies. Although slower than in urban or high-income settings, the uptake of WSPs in low- and middle-income countries (LMICs) is accelerating. Understanding the factors which will make a WSP successful will further improve efficient uptake and assist with its long-term sustainability. Based on an extensive literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISM-A) methodology, 48 publications, including case studies and guidance documentation, formed the basis of this review. These were analysed using inductive and deductive coding methods to (i) identify the success factors applicable to WSP implementation in small drinking water supplies in LMICs and (ii) to investigate which factors are more or less critical depending on the geography and level of development of the implementing country. Key challenges identified during the review process were also noted. A comparison of these success factors was made with those identified from high-income and urban settings. The three most important success factors identified are the development of technical capacity, community engagement, and monitoring and verification. Factors specific to small drinking water supplies in LMICs include support from non-government organisations, integration into existing water sanitation and hygiene (WASH) programs, simplicity, and community engagement. Certain factors, such as adaptability, the use of guidance documentation, international collaboration, the role of pilot studies, knowledge sharing, and stakeholder involvement are applicable to all WSP settings. Due to the specific challenges faced by small drinking water systems and the limited number of original research publications on this topic, this study highlights the need for further data collection and research focused on success factors in these settings. It is anticipated that the consideration of the success factors identified in this study will assist implementers in improving the uptake and long-term sustainability of WSPs in small drinking water supplies in low- and middle-income settings.
Sanitary inspections (SIs) are checklists of questions used for achieving/maintaining the safety of drinking-water supplies by identifying observable actual and potential sources and pathways of contamination. Despite the widespread use of SIs, the effects of training on SI response are understudied. Thirty-six spring supplies were inspected on two occasions, pre- and post-training, by an instructor from the research team and four local inspectors in the Mukono District of Uganda. SI score agreement between the instructor and each inspector was calculated using Lin’s concordance correlation coefficient. Average SI score agreement between the instructor and all inspectors increased post-training for the Yes/No answer type (0.262 to 0.490). For the risk level answer type (e.g., No, Low, Medium, High), average SI score agreement between the instructor and all inspectors increased post-training (0.301 to 0.380). Variability of SI scores between the four inspectors was calculated using coefficient of variation analysis. Average SI score variability between inspectors reduced post-training for both answer types, Yes/No (21.25 to 16.16) and risk level (24.12 to 19.62). Consistency of answer agreement between the four inspectors for each individual SI question was calculated using index of dispersion analysis. Average answer dispersion between inspectors reduced post-training for both answer types, Yes/No (0.41 to 0.27) and risk level (0.55 to 0.41). The findings indicate that training has a positive effect on improving answer agreement between inspectors. However, advanced training or tailoring of SI questions to the local context may be required where inconsistency of responses between inspectors persists, especially for the risk level answer type that requires increased use of inspector risk perception. Organisations should be aware of the potential inconsistency of results between inspectors so that this may be rectified with appropriate training and, where necessary, better SI design and customisation.