Abstract:
:The burden of diarrhoeal disease remains high in the developing world. Community-based safe drinking water programmes are being promoted as cost-effective interventions that will help reduce this illness burden. However, the effectiveness of these programmes remains under-investigated. The primary argument of this paper is that the biological exposure reductions underlying safe water interventions vary tremendously over space and time, and studies that only report results of intent-to-treat analyses cannot reveal why such programmes succeed or fail. The paper develops a stepwise evaluation framework to characterize, and so analyse, the technical, financial, social and behavioural factors that underlie exposure and mediate the impact of safe water investments. Relevant factors include physical performance of the water system, community capacity to maintain and manage the systems, and the time and budget constraints of households participating in the programme. The approach draws on the public health, community-based resource management, and household choice literatures to identify modifiable points of failure along the causal pathway to programme impact. The evaluation framework is used to assess the performance and impact of UVWaterworks, a community-based water purification system in rural Mexico, 5 years after the programme began. No impact on diarrhoea incidence was found in this case. The assessment method revealed that (a) household priorities and preferences were a key factor in maintaining exposure to safe drinking water sources, and therefore (b) user convenience was a primary leverage point for programme improvement. The findings indicate that a comprehensive examination of the many factors that influence the performance and impact of safe water programmes is necessary to elucidate why these programmes fail or succeed.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
deWilde CK,Milman A,Flores Y,Salmerón J,Ray Idoi
10.1093/heapol/czn017subject
Has Abstractpub_date
2008-11-01 00:00:00pages
452-64issue
6eissn
0268-1080issn
1460-2237pii
czn017journal_volume
23pub_type
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