drinking water facilities essay

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Home > Books > Water Challenges of an Urbanizing World

Safe Drinking Water: Concepts, Benefits, Principles and Standards

Submitted: 15 March 2017 Reviewed: 28 September 2017 Published: 21 March 2018

DOI: 10.5772/intechopen.71352

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Water Challenges of an Urbanizing World

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Water is connected to every forms of life on earth. As a criteria, an adequate, reliable, clean, accessible, acceptable and safe drinking water supply has to be available for various users. The United Nation (UN) and other countries declared access to safe drinking water as a fundamental human right, and an essential step towards improving living standards. Access to water was one of the main goal of Millinium Development Goals (UN-MDGs) and it is also one of the main goal of the Sustainable Development Goals (SDGs). The UN-SDG goal 6 states that “Water sustains life, but safe clean drinking water defines civilization”. Despite these facts, there are inequalities in access to safe drinking water in the world. In some countries, sufficient freshwater is not available (physical scarcity); while in other countries, abundant freshwater is available, but it is expensive to use (economic scarcity). The other challenge is the increasing population of the world at an alarming rate, while the available freshwater resources almost remains constant. This chapter presents aspects of safe drinking water - background information, definition of water safety and access, benefits, principles and regulations, factors challenging the sustainable water supply and water quality standards and parameters.

• accessibility
• inequalities
• quality standards

Author Information

Megersa olumana dinka *.

• Department of Civil Engineering Sciences, Faculty of Engineering and the Built Environment, University of Johannesburg, South Africa

*Address all correspondence to: [email protected]

1. Introduction

Water covers more than two-thirds of the earth’s surface, but mostly salty and undrinkable. The available freshwater resource is only 2.7% of the available water on earth but only 1% of the available freshwater (in lakes, rivers and groundwater) is accessible. Most of the available freshwater resources are inaccessible because they are in the hidden part of the hydrologic cycles (deep aquifers) and in glaciers (frozen in the polar ice), which means safe drinkable water on earth has very small proportion (~3%) in the freshwater resources. Freshwater can also be obtained from the seawater by desalinization process. In some countries, sufficient freshwater is not available ( physical scarcity ). In some countries, abundant freshwater is available, but it is expensive to use ( economic scarcity ).

South Africa receives about 450 mm annual rainfall and is classified as a water-stressed country [ 1 , 2 ]. The available freshwater resource can sustain 80 million people only. Some African countries (Ethiopia, Congo and Papua New Guinea) have excess freshwater resources, but they are having water shortage due to economic reasons. Ethiopia, the second populous countries in Africa, is the water tower of east Africa due to the availability of abundant water (nine major river basins). However, the country is among the few countries in the world affected by chronic water problem. The water scarcity in the world is further aggravated by the reduced water quantity (or an increased water demands) due to population growth and the declining of water quality by pollution.

As a criterion, an adequate, clean and safe drinking water supply has to be available for various users [ 3 ]. There is no universally accepted definition of “safe drinking water.” Safe drinking water is defined as the water that does not represent any significant risk to health over a lifetime of consumption [ 4 ]. The safe drinking water must be delivered that is pure, wholesome, healthful and potable. Safe water is not necessarily pure, it has some impurities in it. It contains some traces of salts such as magnesium, calcium, carbonates, bicarbonates and others. The degree of purity and safety is a relative term and debatable. Clean/pure water has no minerals and it only contains H and O. According to the Monitoring organizations under the supervision of the Joint Monitoring Programme (JMP), “safe drinking water” is defined as water from an “improved water source,” which includes household connections, public standpipes, boreholes, protected dug wells, protected springs and rainwater collections. According to the same organization, “access to safe drinking water” is defined as the availability of at least 20 l per person per day from an “improved” source within 1 km of the user’s dwelling.

Safe drinking (potable) water is the water that can be delivered to the user and is safe for drinking, food preparation, personal hygiene and washing [ 3 ]. The water must meet the required (chemical, biological and physical) quality standards at the point of supply to the users [ 5 ]. Therefore, safe drinking water is a relative term, which depends on the standards and guidelines of a country; the standards set for the different quality parameters are different. The standard of WHO is not exactly the same as that of USA, Canada, European Commission, Russia, India, South Africa, Ethiopia, and so on. The term “safe” depends on the particular resistance ability of an individual. Water that is safe for drinking in some African countries might not be safe in European countries. Some African countries already developed resistance to some of the water-related diseases.

Safe drinking water is anonymously accepted as an international agenda and priority, which is evident from the MDGs and SDGs of the United Nations (UN) initiative and vision (MDGs 7 and SDGs 6). Despite the MDGs effort, still many people lack access to safe drinking water, even lack access to basic water. Globally, more than 1 billion people do not have access to safe drinking water. According to the Third World Academy of Sciences (TWAS) report [ 6 ], contaminated/dirty water is killing more people than cancer, AIDS, wars or accidents. Population of the world is increasing and the available freshwater resources almost remain constant. The number of people without access to safe drinking water is increasing. This is mostly related to the ever-increasing population growth in the developing countries and the inability (or unwillingness) of governments (local and national) to provide adequate water supply facilities in these countries [ 7 ].

2. Drinking water safety and access

2.1. access to safe drinking water.

Water is connected to every form of life on earth and is the basic human need, equally important as air. Water is connected to every aspect of human day-to-day activities directly or indirectly. At a basic level, everyone needs access to safe water in adequate quantities for drinking, cooking, personal hygiene and sanitation facilities that do not compromise health or dignity. Therefore, access to safe and dependable (clean and fresh) water is the fundamental/basic right of humans [ 8 ]. The UN and other countries declared that access to clean, safe drinking water is a basic human right, and an essential step toward improving living standards worldwide. Access to water was one of the main goals of UN-MDGs and it is also one of the main goals of the UN-SDGs. The South African constitution declares “ access to water and food for all ” as the main goal in the constitution following the 1998 National Water Act [ 9 ]. Despite these facts, still there are inequalities in access to safe drinking water in South Africa and in the world, the problem has more impacts on the poor, women and children. There are also inequalities within and among nations [ 6 ]. For instance, the population with access to safe drinking water in Congo was 77% for rural dwellers and 17% for rural dwellers by the year 2002 [ 6 ]. Inequalities in access to water and sanitation are morally unacceptable, but they are prohibited under international law [ 3 ].

Globally, it is estimated that 89% of people have access to water suitable for drinking [ 10 ]. According to UNDP [ 11 ] report, one out of six people do not have access to clean water, that is, about 1.1 billion people lack access to safe drinking water. In some countries, especially in Africa, almost half of the population do not have access to safe drinking water and hence, is afflicted with poor health [ 12 ]. The number of people without safe drinking water is more than the number reported by UNDP [ 11 ]. This is due to the fact that most of the water supply facilities initiated during the MDGs in developing countries are not functioning properly.

2.2. Benefits of safe drinking water

Water of satisfactory quality is the fundamental indicator of health and well-being of a society and hence, crucial for the development of a country. Contaminated water not only has the potential to pose immediate threat to human, but also can affect an individual productive rate [ 13 ]. According to the WHO [ 14 ] report, an estimated 1.1 billion people in the world drink unsafe water. Approximately 3.1% of the global annual death (1.7 million) and 3.7% of the annual burden (disability) (54.2 million) are caused by the use of unsafe water and lack of basic sanitation and hygiene.

Water provides a number of benefits and services for humans and the ecosystem. As reported by OECD [ 15 ], the benefit of water is not documented sufficiently, resulting in low political priority for water issues and in suboptimal levels of investment in water infrastructures. The same document also indicates that the benefit of water is mostly hidden in other technical documents. Most researchers have indicated that the benefit-cost ratio of access to water is more than 2, and in some cases, it can reach 7.0. In developing countries like Africa, the benefit-cost ratio of access to water is very high (more than 5:1 ratio) because it is related to every dimension of developmental activities (agriculture, energy, industry, etc.). In such areas, the return on investment in water services usually result in a substantial economic gains, estimated in the range of 5–28 USD per 1 USD [ 7 ]. In addition to the economic gains, water supply projects have technical, environmental and political gains. Water sector is interconnected with other development sectors (agriculture, energy, industry, etc.) and factors (social, economic, environmental, health, educational, legal and political) at local, national levels, regional and international levels [ 16 ]. In fact, access to safe water has a number of direct and indirect benefits related to health, education, poverty and environment. The UN World Water Development Report [ 7 ] indicated that there is a linkage or nexus between water and sustainable development, far beyond its social, economic and environmental dimensions. The report clearly indicated that access to safe water has a great role in addressing the developmental challenges, such as human health, food and energy security, urbanization and industrial growth, as well as climate changes. Especially, there is a strong nexus between water, food and energy [ 3 ].

The MDGs of the UN targeted to “ halve the population without access to safe drinking water and basic sanitation” in the period from 1990 to 2015. According to the report by WHO and UNICEF [ 17 ] through their Joint Monitoring Programme (JMP) for water supply and sanitation, about 2.3 billion people have gained access to an improved drinking water. The report indicates an impressive gain has been made in the past two decades, but much has to be done. The success of MDGs is even doubtful since many of developing countries, especially the poor are still struggling to get access to safe drinking water. As stated in Section 2.1, the number of people without access to safe drinking water is more than the value reported by the UN.

Research has shown that the majority of people without access to safe water are from developing nations [ 18 ]. This shows that many people in the developing world, especially Africa, still depend on unsafe water sources for daily water need and affected by chronic water problems and water-borne diseases. Millions of people die due to water-related diseases like cholera, diarrhea, malaria, dengue fever, and so on. Globally, water-borne diseases kill more than 25,000 people per day and about 5000 children die per day due to water-related diseases (mainly diarrhea) [ 12 ], most of them can be easily prevented. Diarrhea and related diseases kill about 1.8 million children every year, most of them are in developing countries [ 19 ]. It is also estimated that about 1.8 billion people drink water contaminated with Escherichia coli (indicator of fecal contamination) [ 20 ]. In many parts of the world, especially developing countries, water-borne diseases represent the leading cause of death. Thus, access to safe water means a reduction of water-related diseases. It is an opportunity for improved health because it reduces the outbreak of health hazards.

In cognizant to the benefits of water, the newly introduced ambitious Sustainable Development Goal (SDG) by UN in 2014 [ 21 ] considers water as one of the main developmental pillars under SDG 6. In fact, water was also one of the main goals of the UN-MDGs. The UN-SDG 6 states that “ Water sustains life but safe, clean drinking water defines civilization. ” The UN-SDG 6 recommended a dedicated SDG for water under five target areas such as (i) WASH, (ii) water resources, (iii) water governance, (iv) water quality and wastewater management and (v) water-related disasters. This indicates that the benefit-cost ratio of water is very high since it has social, economic, financial and environmental benefits. The benefit of water extends to other developmental activities/sectors such as health, education, agriculture and food production, energy, industry and other social and economic activities [ 7 ]. Therefore, achieving the UN’s SDG 6 seems very hard, especially in the poorest countries like Africa where there are lots of problems and challenges. It requires dramatic improvement to the quality of life and longevity [ 7 ]. If we declare that “access to clean safe drinking water is a basic human right, then providing the necessary education, infrastructure and support to ensure the success of SDG 6 is the responsibility of us all.” In developing countries, improving access to safe water requires the establishment of good governance [ 22 ].

3. Basic principles of safe drinking water supply

3.1. definition of terms.

There are basic standards, norms, criterion and indicators for safe drinking water. There are also policies, strategy and program under safe drinking water. These terms are well defined by Bos et al. [ 3 ]. Norm refers to the standard of development related to the large group of society. Criterion refers to the agreed norm or standard used for the decision. Indicator refers to the measured value of individual water quality parameters. Standard refers to the agreed target/threshold value established as an agreed target, which is set by an authority. There are various water quality standards and criteria in the world. Details of the water quality standards are provided under Section 5.3.

3.2. Water regulations and act

Water regulations are important for the provision of drinking water that is sufficient in quantity, safe, accessible, acceptable, affordable and reliable. Drinking water regulations include controlling of the water supply systems which are water source, water treatment, distribution, use, wastewater and gray water. Countries regulate drinking water differently depending on the quality of their water source. As stated earlier, different countries regulate drinking water differently depending on the quality of their water source.

In South Africa, water sources are monitored by the Department of Water and Sanitation (DWS). This was achieved by the implementation of the National Water Act (NWA) 36 of 1998 [ 9 ]. The purpose of the NWA is to ensure that the nation’s water resources are protected, used, developed, conserved, managed and controlled. Local authorities are responsible for the supply of water to residents. This was achieved by the implementation of the Water Services Act (WSA) 108 of 1997. WSA are established to provide the following services [ 9 ]: (1) ensuring the rights of access to basic water supply and sanitation; (2) setting national standards, norms and tariffs; (3) water service development plans; (4) prepare the regulatory framework for water service institutions and intermediaries; (5) establish and disestablish committee for water boards and water services and their powers and duties; (6) monitoring water services and intervention and (7) providing financial assistance to water service institutions.

As a criterion, an adequate, clean and safe drinking water supply has to be available for various users [ 3 ]. Moreover, water has to be accessible for all, including children, elders and disabled ones. Water availability refers to both sufficient quantities and reliability of service provisions. Adequacy refers to both the quality and quantity of water. Reliability refers to continuity of the service provision for the current and future generation, which is covered under the principle of sustainability, system robustness and resilience. Acceptability refers to esthetic value of water – the acceptable appearance, taste and odor of water. It is highly subjective parameter and largely depends critically on the perceptions of the local ecology, culture, education and experience and hence, there is no set clear and objective global acceptability standards. Accessibility to water refers to the accessibility to a reliable supply of water on a continuous basis close to the point of demand: within everyone’s reach: home, school, work, public places. It is related to the distance of water source from the point of demand (30 minutes walk or 0.2 km). That means the water has to be accessible for everyone, including children, elders and disabled ones. The detailed definition of the above water variables can be obtained from Bos et al. [ 3 ].

The role of a drinking water supplier is to provide adequate water for the community and prevent/mitigate risk of water contamination in different elements/points of water supply system such as source, treatment and distribution. They also should assure the delivery of a safe and esthetically pleasing drinking water to the consumer’s point. In general, the prevention, mitigation and elimination of water contamination are the responsibilities of water providers and regulators. Water regulations are also important for the provision of drinking water that is sufficient in quantity, safe, accessible, acceptable, affordable and reliable. Countries regulate drinking water differently depending on the quality of their water source. According to the WHO [ 23 ] and US Environmental Protection Agency [ 24 ], there are guidelines and principles that need to be followed for water to be considered fit for use. The guidelines are as follows: physical, microbial, chemical and radiological. The water quality standards for different countries are summarized under Section 6.1.

4. Potential factors challenging water supply systems

The water supply system (WSS) is a system of hydrologic and hydraulic components, including all buildings and installations, used to meet water requirement of industrial and population centers. It consists of capturing raw water, drainage basin, water capturing and transmission pipes, water treatment plants, treated water transfer pipes, drinking water adduction pipes, pumping stations and pumping, water storage tanks and water distribution networks to the consumers [ 25 , 26 , 27 ]. A conventional water supply system is a combination of complex subsystems, consisting of the water supply catchment, water storage reservoir, water treatment plant and water distribution network [ 26 ]. Water supply and distribution systems typically comprise a combination of source works, treatment facilities, service reservoirs, pumping stations, pipes, valves and so on [ 25 ].

4.1. Sustainable water supply and challenges

In the ambitious vision 2050 of the SDG, sufficient and safe water has to be available for all to support human’s basic needs and ecosystem integrity [ 7 ]. The sustainable development of the world largely depends on the sustainable development of water since other sectors are interrelated with water resources. It requires the progress of the three dimensions of the sustainable development (social, economic and environmental) [ 7 ]. Thus, the vision of SDGs (goal 6) for water requires management of the available water and related resources in an integrated, inclusive and participatory approach. Huge investment is highly needed for infrastructure, treatment plant systems and water recycling [ 29 ].

A WSS may face a number of challenges associated with many factors in provision of quality, efficient, reliable, resilient and sustainable water supply for the present and future generations. Rural areas are facing more financial and technical difficulties than urban areas. According to da Silva et al. [ 29 ], wealthier urban areas have more financial capacity and technical expertise than the poor rural communities to raise the capital needed for water infrastructure. Especially in rural areas with arid environment and great hydrologic variability, reliable and dependable WSS requires energy intensive infrastructure. A study made by Chung et al. [ 30 ] showed that robust optimization approach is a useful tool in reliable WSS design, under uncertainty, that prevents system failure at a certain level of risk.

Achieving the SDG requires huge capital investment and good governance , which is lacking in developing countries. Huge investment is highly needed for infrastructure, treatment plant systems and water recycling [ 28 ]. The sustainable development of water sector is affected by the sustainable development of the other sectors. Unsustainable developmental activities are greatly threatening the quantity and quality of renewable freshwater resources. Various driving forces are threatening the sustainability of WSS such as population increase at alarming rate, high rate of urbanization, significant land cover and climate change, the high demand for new energy supplies and poor governance. These driving factors are causing an increasingly frequent water shortage, floods and droughts, deleterious runoff, coastal hypoxia and depleted aquifers [ 28 ]. They have challenged the success of MDGs and will continue challenging the achievement of the newly set MDGs.

The other challenge of sustainable water supply is the lack of appropriate policies and programs that consider rural diversity. Small rural communities are the most vulnerable to water contamination. Furthermore, they struggle to secure the necessary funds for infrastructure necessary to improve water treatment and delivery systems, and thus fail to meet drinking water quality regulations. Community management is the tendency to provide water to rural areas worldwide. Despite the diversity of rural communities and their water supplies, policies tend to be uniform. A quantitative and qualitative study made in the Colombian Andes on four rural water supplies by considering aspects of infrastructure, training of human resources, revenue collection, water quality and post-construction support [ 31 ]. The study concluded that there is a need to design policies and programs that consider rural diversity to facilitate the sustainable water supply services. According to Kot et al. [ 32 ], policymakers have to align small communities with appropriate water quality goals by considering the contextual and cultural differences among rural communities.

In urban areas, the infrequent and insufficient application of adaptive capacity indicators in urban sustainable water supply systems has led to the challenge of dynamic and uncertain urban water supply systems. This condition is threatening the sustainability of urban water supply systems and raises concerns about the progress of urban water systems for variation and change [ 33 ]. As suggested by Spiller [ 33 ], future research should focus on developing methods and indicators that can define, evaluate and quantify adaptive capacity indicators under the three dimensions of sustainable development ( economic, environmental and technical ). Therefore, there is an urgent need to move toward the use of adaptive capacity indicators.

Moreover, there is an urgent need to move toward sustainable and resilient smart water grids in urban areas. Urban water supply systems are facing challenges of sustainability and resiliency, including water leaks, over-use, quality issues and response to drought and natural disasters [ 34 ]. Information and communications technology could help address these challenges through the development of smart water grids that network and automate monitoring and control devices [ 34 ]. While impressive progress has been made on technological elements (information and communication), the application of a smart water grid has received scant attention, especially in developing countries.

In fast-growing urban regions, water demand and supply modeling is extremely important. An accurate prediction of water demand plays a crucial role for water service providers in the planning, design and water utility asset management of drinking WSS. However, accurate prediction is always challenging due to the fact that predicting models require a simultaneous consideration of a number of factors affecting water demand and supply pattern. Some of the factors include climate changes, economic development, population growth, migration and consumer behavioral patterns [ 35 ].

4.2. Challenging factors for water supply systems

There are a number of factors challenging WSS. Some of the factors are aging infrastructure, water service provision thinking horizons, catchment (mountain)-specific issues, climate change, knowledge gaps with respect to present and future hydrology, accurate water demand prediction, land use/cover change, optimal operation of water supply systems, cost recovery, operating cost, water quality (water pollution), water scarcity, water leaks, low water pressure, over-use, response to drought and natural disasters, rapid urbanization, population growth, migration, demographic changes, economic development, consumer behavioral patterns, efficiency and reliability of a water supply system, self-sufficiency through use of alternative water sources, dynamic and uncertain urban water systems, complex dynamic human-environment coupled systems (non-holistic or siloed management), lack of adaptive capacity indicators to assess sustainability of water systems, scant attention of smart water grids (not supported by information and communications technology), lack of policies and programs that consider rural diversity and cultural differences and neglecting wastewater management are mentioned as challenges to water supply systems for provision of sustainable and reliable water services, which meet acceptable standards for present and future generations [ 14 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].

According to Berg and Danilenko [ 38 ], WSS has faced a number of global challenges in the twenty-first century. The major challenges are population growth, uncertain climate changes, socio-environmental issues, limited water resources, economic crises and continuous aging process. There are a number of problems associated with the continuous aging process, including low pressure, water loss and water quality deterioration [ 36 ]. The major challenges in the provision of safe water and sanitation on a global basis are [ 37 ]: (1) water contamination within distribution systems; (2) increasing water scarcity and shortages; (3) implementing innovative and low-cost sanitation systems; (4) providing sustainable water supply systems and sanitation for megacities; (5) reducing the disparities in access to water and sanitation and (6) developing financially feasible water and sanitation services.

Increasing urban water self-sufficiency: The main drivers for increased self-sufficiency were identified to be direct and indirect lack of water, constrained infrastructure, high-quality water demands and commercial and institutional pressures. Public water service providers should plan to achieve a high level of reliable, stable and dependable water supply, which can be achieved by combining alternative water supply systems with the conventional ones. A case study made by Rygaard et al. [ 39 ] demonstrated an increase in water self-sufficiency ratios to more than 80% when the conventional water supply was supplemented by water recycling, seawater desalination and rainwater harvesting. However, the study indicated that care should be made during the introduction of alternative freshwater sources since it may raise several challenges such as very high-energy requirements (> tenfold ) by the alternative techniques, appearance of trace contaminants in recycled wastewaters and the possible resistance from consumers due to the changes made to the drinking water system. The study concluded that despite the challenges, urban water self-sufficiency concepts in combination with conventional water resources are already helping to reach the goal of urban WSS.

Infrastructure development: Water services are in crisis or approaching crisis conditions due to the neglect of infrastructure, particularly underground water mains and sewers, largely because of political unwillingness to allow charges to be set high enough to achieve sustainable cost recovery. This is true in both developed and developing countries [ 43 ]. In developed countries, the solutions are relatively affordable; what is needed is the political commitment to take action. In developing countries, the situation is more serious due to a combination of neglect and rapidly growing urban populations. Without doubt, infrastructure is essential for sustainable water development. But infrastructure alone will not contribute to the improvement of the quality of life unless it is part of an overall framework: development, economic growth, social equity and environmental protection. As mentioned by the Nobel laureate Amartya Sen [ 45 ], “the absence of infrastructure has a pervasive influence on poverty, but at the same time is not a free-standing factor in lifting people from it.” Thus, the focus should be the use of physical infrastructure as a driver for sustainable development. But infrastructure development takes more time beyond the life of most governments. The thinking of water service providers has to be based on long-term horizons. In order to improve the accountability and social welfare of relatively low-income households, there is a need for more comprehensive frameworks (institutional, legal, regulatory, policy and management) than the existing ones at present [ 45 ]. Venkatachalam [ 47 ] suggested that improving the existing public water supply to a satisfactory level will improve the household’s willingness to pay because the willing households could reap significant benefits from the improved supply. This would help the government agencies to come out with an improved water tariff policy that will cover cost of investment and maintenance.

Urban water pricing ( cost recovery, affordability and water conservation ): Policymakers increasingly consider pricing as an important tool for cost recovery, affordability and water conservation to address water scarcity issues. However, implementing tariff reforms is often difficult in practice due to political factors and the absence of governance structures that can result in quality service provision. Additionally, institutional replication of successful water pricing policies has been difficult due to incomplete information and the contextual uniqueness of local institutions, politics and social relations. Water service provision thinking has to be based on long-term horizons. Infrastructure development takes time beyond the life of most governments. In those countries without such political continuity, there is a need for all political factions to agree on goals, policies and plans. It is unlikely that water can ever be separated from politics, but city political consensus must be attempted [ 53 ].

Climate change : Climate change is affecting the frequency of extreme weather events and hence increasing the uncertainty about water availability and reliability [ 50 ]. A properly planned, developed and managed infrastructure and related institutional capacities are required in order to buffer seasonal climatic variations and address water demand issues. More emphasis should be given to mountain-specific issues. Major priority areas include water governance for transboundary basins, cross-border information systems, establishing a knowledge base for mountain regions and sharing benefit between mountain and downstream communities [ 42 ].

Knowledge gaps: With respect to present and future, hydrology poses a serious constraint for infrastructure development. Changing hydrology will pose special challenges to the design, planning and management of infrastructure [ 42 ]. Land use influences raw surface water quality and treatment costs for drinking water supply [ 51 ]. Anthropogenic disturbances to the environment can compromise valuable ecosystem services, including the provision of potable water. These disturbances decrease water quality, potentially increasing treatment costs for producing drinking water.

Efficiency and reliability of a water supply system: Water inflow is among primary determinants of the successful functioning of the entire water supply system since it influences water storage. Developing an approach to assess the resilience of WSS under limited rainfall provides useful insights into effective system management [ 26 ]. For instance, understanding WSS resilience can support the identification of the minimum/threshold rainfall value by which WSS can maintain its operation without failure. It can also help to understand and identify the sensitivity of the WSS to a changing rainfall amount and distribution pattern. In this regard, the water service providers are well aware of the stability of WSS and know when the system experience a pressure or disruptive influences.

Challenges for water supply and Governance: Cities struggling to keep pace with population and demographic changes are not unique. According to a study conducted in Dublin [ 41 ], collectively there are combinations of factors that create an inordinately challenging situation for those attempting to plan for the city’s current and future water resources needs. Their main challenges related to topography, old infrastructure (the nineteenth century), population growth and development needs, water charges, climate change and water supply history.

5. Drinking water quality

5.1. definition and concepts.

Water is most fundamental in shaping the land and regulating the climate. It is one of the most important resources that profoundly influence life. Water quality is the most fundamental controlling factor when it comes to health and the state of diseases in both humans and animals. According to WHO report [ 23 ], about 80% of all the human diseases in human beings are caused by water.

Depending on the purpose of water quality analysis, water quality can be defined based on a set of biological, physical and chemical variable, which are closely linked to the water’s intended use. As a principle, drinking water is supposed to be free from harmful pathogens and toxic chemicals [ 3 ]. Contamination of freshwater (especially groundwater) sources is one of the main challenges currently faced by the South Africans, more especially in communities who depend almost exclusively on groundwater [ 52 ]. Groundwater is used for domestic, industrial and agricultural water supply in all four corners of the world. Therefore, the presence of contaminants in natural freshwater continues to be one of the most important environmental issues in many areas of the world, more especially in developing countries [ 53 ]. Once the groundwater is contaminated, its quality cannot be restored back easily, the best way is to protect it.

The concept and theory of water quality is very broad since it is influenced by many factors. Water quality is based on the intended uses of water for different purposes, that is, different water uses require different criteria to be satisfied. In water quality analysis, all of the accepted and unaccepted values must be clearly defined for each quality variable. If the quality variables meet the pre-established standards for a given use is considered safe for that use. When water fails to meet these standards, it must be treated if possible before use.

5.2. Description of water quality parameters

5.2.1. physical parameters.

Physical quality parameters are related to total solids content, which is composed of floating matter, settleable matter, colloidal matter and matter in solution. The following physical parameters are determined in water [ 12 ]:

Color : caused by dissolved organic materials from decaying vegetation or landfill leachate.

Taste and odor : can be caused by foreign compounds such as organic compounds, inorganic salts or dissolved gases.

Temperatures : the most desirable drinking water is consistently cool and does not have temperature fluctuation of more than a few degrees. Groundwater generally meets these criteria.

Turbidity : refers to the presence of suspended solid materials in water such as clay, silt, organic material, plankton, and so on.

5.2.2. Chemical parameters

The chemical constituents have more health concerns for drinking water than for the physical constituents. The objectionability of most of the physical parameters are based on esthetic value than health effects. But the main objectionability of some of the chemical constituents is based on esthetic as well as concerns for adverse health effects. Some of the chemical constituents have an ability to cause health problems after prolonged period of time [ 54 ]. That means the chemical constituents have a cumulative effect on humans. The chemical quality parameters of water include alkalinity, biological oxygen demand (BOD), chemical oxygen demand (COD), dissolved gases, nitrogen compounds, pH, phosphorus and solids (organic). Sometimes, chemical characteristics are evidenced by their observed reactions such as in laundering, redox reactions, and so on [ 12 , 54 ].

Below is a list of some of the chemical compounds and elements found in water:

Arsenic : occurs naturally in some geologic formation. It is mostly used in agricultural chemicals in South Africa. In drinking water, it has been linked to lung and urinary bladder cancer.

Chloride : most waters contain some chloride. The amount found can be caused by the leaching of industrial or domestic waters. Chloride should not exceed 100 mg/L in domestic water to be palatable.

Fluoride : is a natural contaminant of water. It is one of those chemicals given high priority by WHO [ 14 ] for their health effects on humans. High F in drinking water usually causes dental and skeletal fluorosis. Excessive F (>2 mg/L) causes a dental disease known as fluorosis (mottling of teeth), while regular consumption in excess may give rise to bone and skeletal fluorosis [ 12 ]. On the other hand, F < 2 mg/L causes dental cavities in children.

Zinc : is found in some natural waters, particularly in areas where zinc ore deposit have been mined. Though it is not considered detrimental to health, but it will impart a bad taste to drinking water.

Iron : small amounts of iron frequently are present in water because of the large amount of iron in the geologic materials. This will cause reddish color to water.

Manganese : naturally occurring manganese is often present in significant amounts in groundwater. Anthropogenic sources include discarded batteries, steel alloy production and agricultural products.

Toxic substances : generally classified as inorganic substances, organic substances and heavy metals. The toxic inorganic substances include nitrates (NO 3 ), cyanides (CN_) and heavy metals. These substances are of major health concern in drinking water. High NO 3 content can cause Methemoglobinemia in infants (“infant cyanosis” or “blue baby syndrome”); while CN can cause oxygen deprivation [ 12 ]. There are more than 120 toxic organic substances [ 24 ], generally exist in the form of pesticides, insecticides and solvents. These compounds produce health effects (acute or chronic). The toxic heavy metals are arsenic (As), barium (Ba), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), selenium (Se) and silver (Ag) [ 12 ]. Like the organic substances, some of these substances are acute poisons (As and Cr) and others produce chronic diseases (Pb, Cd and Hg).

5.2.3. Biological parameters

Biological parameters are the basic quality parameters for the control of diseases caused by pathogenic organisms, which have human origin. Pathogenic organisms found in surface water include bacteria, fungi, algae, protozoa, plants and animals and viruses. Some of these disease-causing organisms (bacteria, fungi, algae, protozoa and viruses) are not identifiable and can only be observed microscopically. Microbiological agents are very important in their relation to public health and may also be significant in the modification of physical and chemical characteristics of water [ 12 ]. Water for drinking and cooking purposes must be free from pathogens. The greatest microbial risks are associated with consumption of water that is contaminated with human or animal feces. Feces can carry pathogenic bacteria, protozoa, helminthes and virus. Pathogens originating from feces are the principle concerns in setting health-based targets for microbial safety. Water-borne diseases are particularly to be avoided because of the capacity of result in the simultaneous infection of large number of people. While water can be a very significant source of infectious organisms, many of the diseases that may be waterborne may also be transmitted by other routes, including person-to-person contact, droplets and aerosols and food intake [ 54 ].

The techniques for comprehensive bacteriological test are complex and time consuming. Different tests have been developed to detect the relative degree of bacterial contaminations in terms of an easily defined quantity. There are two mostly used test methods widely used to estimate the number of microorganism of coliform groups ( Escherichia coli and Aerobacter aerogenes ). These include: total coliforms or E. coli , but the second one is found to be a better indicator of biological contamination compared to the first one [ 12 ].

5.3. Water quality standards

As presented in Section 3.1, standard is defined as a basis for judging the quality. A standard for drinking water quality is thus the reference that will ensure that the delivered water will not pose any threat or harm to human health. The water quality standard is the framework against which a water sample can be considered satisfactory or safe for use [ 54 ]. There are a number of standard guidelines for drinking purposes such as World Health Organization [ 54 ], Commission for European Union [ 55 ], U.S. Environmental Protection Agent [ 24 ], Environmental Canada [ 56 ], Russian Standard [ 57 ], Indian Standard [ 58 , 59 ], South African National Standard [ 60 ] and Ethiopian Standards [ 61 ]. Most developing and other developed countries use the WHO standards for drinking water [ 54 ]. Table 1 summarizes water quality guidelines of different countries.

Table 1.

Comparison of the different drinking water standards.

P – probability (%); HDL – highest desirable limit; MPL – maximum permissible limit; USEPA – United States Environmental Protection Agency; CEU – Commission of European Union; EC – Environmental Canada.

Sources: a WHO [ 54 ], b USEPA [ 24 ], c CEU [ 55 ], d UNESCO/WHO/UNEP [ 56 ], e Health Canada [ 57 ], f ISI [ 58 ] and BIS [ 59 ], g SANS [ 60 ], h ESA [ 61 ]. Note that the values indicated for the different standards other than WHO are the maximum permissible limits.

5.4. Water quality index

It is difficult to quantify the overall suitability of water for drinking based on the various guidelines presented in Table 1 . The interpretation of the various water quality parameters separately is usually a difficult task for general public as well as decision and policy makers. Therefore, the calculation of a general water quality index (WQI) is extremely important in order to communicate the quality of water in a better and understandable ways. There are different approaches of calculating WQI. In this section, a brief description has been provided for the weighted Arithmetic Water Quality Index Method proposed by Tiwari and Mishra [ 62 ] and adopted by others [ 63 , 64 , 65 , 66 , 67 ]. The quality rating (q i ), the sub-index (SI) [ 65 ] and the relative weights (Wi) are calculated using Eqs. (1) – (3) .

where V i and S i are the analytical and the standard value for the i th parameter, respectively, V o is the ideal value of the i th parameter in pure water (V o  = 0, except pH =7.0). The standard value is usually considered as the maximum permissible level set by WHO [ 10 , 14 , 54 ] or as per the standards for different countries presented in Table 1 . W i is the relative weights for various water quality parameters, assumed to be inversely proportional to the recommended standards for the corresponding parameters. w i is the unit weight of each parameter according to its relative importance in the overall quality of water for drinking purposes. The w i values are provided by Tiwari and Mishra [ 62 ], which depend on the number of parameters considered in the calculation of WQI. Note that the ∑W i should be equal to 1.

Finally, the overall WQI ( Eq. (4) ) is calculated for each of the water sources by aggregating the quality rating (q i ) linearly and taking their weighted mean.

WQI classes are as follows: 0–25 (excellent, grade A), 26–50 (good, grade B), 51–75 (poor, grade C), 76–100 (very poor, grade D), >100 (unfit for drinking, Grade E).

6. Conclusion

As water is a basic need for human life, access to clean, safe drinking water is a basic human right. As a criterion, an adequate, reliable, clean, acceptable and safe drinking water supply has to be available for various users. Moreover, everyone needs access to safe water in adequate quantities for drinking, cooking and personal hygiene and sanitation facilities that do not compromise health or dignity. Access to water is one of the most important catalysts given high priority by the UN for sustainable development. Despite these facts, there are inequalities in access to safe drinking water in the world. There are a number of factors challenging the sustainable WSS. Some of the factors are related to infrastructures (aging), clean water issues (quality, scarcity), natural factors (climate change, flood and drought), human factors (population growth, migration, demographic change, economic development, willingness to pay for water supply services, overuse), water management and delivery problems (pressure, leakages, lack of smart water meters, cost recovery, operation costs, etc.).

MDG fails to achieve its goal for access to safe water and sanitation. The chance for the success of the newly set SDG is also not different from that of MDGs, especially in some African countries. Some of the African leaders are reporting a false number of people with access to safe drinking water and sanitation to get a donation from the UN and using the donated money to buy weapons and use it to suppress the right of the people. In developing countries, improving access to safe water requires provision of good quality education and the establishment of good governance. Priorities should be given to the development of a democratic government and community empowerment.

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Open Access

Peer-reviewed

Research Article

Community perceptions and practices on quality and safety of drinking water in Mbarara city, south western Uganda

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization, Writing – review & editing

Roles Methodology, Supervision, Validation, Visualization, Writing – review & editing

Roles Conceptualization, Methodology, Project administration, Supervision, Validation, Visualization, Writing – review & editing

Affiliation Faculty of Science, Mbarara University of Science and Technology, Mbarara, Uganda

Roles Conceptualization, Data curation, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Writing – review & editing

• Abaasa N. Catherine, 
• Savino Ayesiga, 
• Godfrey Zari Rukundo, 
• Julius B. Lejju, 
• Frederick Byarugaba, 
• Imelda K. Tamwesigire

• Published: May 30, 2023
• https://doi.org/10.1371/journal.pwat.0000075
• Peer Review
• Reader Comments

Availability of clean drinking water is a universal human right. The quality of water differs across communities. When the quality is good, community members are the primary beneficiaries but they are also the first ones to experience the consequences of deteriorating quality of water. In most communities, the inhabitants are able to tell if their drinking water is safe and of quality basing on organoleptic properties. The community perceptions and practices about safety and quality of drinking water are informed by their attitudes and levels of knowledge about water quality. This study aimed to assess community perceptions and practices on quality and safety of drinking water in Mbarara city, south western Uganda. A qualitative study was conducted between May and July 2022. Six focus group discussions among community members and four Key informant interviews with stakeholders in the water service were conducted. Data was analysed basing on predetermined themes of: 1) perceived quality of water 2) perceived factors associated with water quality 3) practices related to water quality and 4) perceived solutions for improving water safety and quality. Drinking water safety and quality in Mbarara city is perceived as not good, dirty, salty and limited in supply and the water sources are shared with animals. The poor quality of drinking water is due to poor waste disposal, poor treatment, poor maintenance of systems, flooding, political interference, deficiency in city planning, increase in population growth and water hyacinth. Sensitizing the communities, community participation, proper water treatment and surveillance and monitoring are solutions to ensuring provision, use and maintenance of safe and quality drinking water in Mbarara city.

Citation: Catherine AN, Ayesiga S, Rukundo GZ, Lejju JB, Byarugaba F, Tamwesigire IK (2023) Community perceptions and practices on quality and safety of drinking water in Mbarara city, south western Uganda. PLOS Water 2(5): e0000075. https://doi.org/10.1371/journal.pwat.0000075

Editor: Eugene Appiah-Effah, Kwame Nkrumah University of Science and Technology, GHANA

Received: October 31, 2022; Accepted: April 29, 2023; Published: May 30, 2023

Copyright: © 2023 Catherine et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: To ensure confidentiality of participants’ information as agreed up on during Ethical approval and Consent Process, qualitative interview transcripts’ file is only visible to the direct research team or through Mbarara University of Science and Technology Research Ethics Committee, P.O. Box 1410 Mbarara, Tel: +256-48-543-3795, Fax: +256-48-542-0782, E-mail: [email protected] , [email protected] since they are not publically available.

Funding: The corresponding author who happens to be the PI for this study CNA received research support as part of Faculty Research Support from Faculty of Medicine, Mbarara University of Science and Technology (MUST). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: NWSC, National Water and Sewerage Cooperation; NEMA, National Environment Management Authority; UBOS, Uganda Bureau of Statistics; WASH, Water, sanitation, and hygiene

Introduction

Safe and quality water is defined as one free from any harmful chemicals and pathogenic agents such as Coliform bacteria, Escherichia coli and coliphages that affect its palatability as well as human livelihood [ 1 , 2 ]. According to the United Nations Sustainable Development Goal 6, “water sustains life, but safe clean drinking water defines civilization” [ 3 ]. Drinking water should be adequate, reliable, clean, accessible and acceptable to communities as a human right to live healthy lives [ 4 ]. There is evidence that steps aimed at providing safe water services have fairly increased, but its safety is uncertain [ 5 ]. Most households in low and middle income countries lack sufficient safe and quality freshwater (physical scarcity). In other countries there is abundant freshwater of unknown quality hence communities supplement improved water supplies with unimproved water or multiple sources that may not be safe for human consumption because it is expensive to ensure adequate supply of safe and quality water [ 6 , 7 ]. Safe drinking water” is water from an “improved water source,” that include household connections, public standpipes, boreholes, protected dug wells, protected springs and rainwater collections and it should not represent any significant risk to health over a lifetime of consumption [ 8 , 9 ]. Assessment of water quality is subjective and is based on beliefs, cognition, geographic location of the water source, socio economic characteristics, the experience of the user and information provided by local media [ 10 ].

Community members are the primary beneficiaries of quality and safe water and they are the first to experience the consequences of the deteriorating water quality when known or suspected to be unsafe for human consumption due to regulatory problems and lack of support [ 11 ]. They evaluate the safety and quality of drinking water using its organoleptic properties like taste, smell, colour and clarity as well as presence of litter and sanitary conditions around the drinking water source [ 12 ]. These perceptions are however useful and help to complement scientific measurements hence supporting water management policies [ 13 ]. Community participation in water and sanitation is one of the prominent global indicators used to assess the achievement of water-related sustainable developmental goals [ 12 ]. In addition, public acceptability of drinking water is one of the world health organization guidelines for drinking water quality [ 14 ].

Communities’ perception of the quality of drinking water is informed by health risk perception, perceived control, past experience, trust on water service provider, influence of impersonal and interpersonal information like media and peers, contextual factors, colour, taste of the water, appearance and demographic variables [ 15 , 16 ]. However, these perceptions are influenced by sociocultural, sociodemographic, and personal experiences and are shaped by service satisfaction, confidence in local and national authorities, selection of the water source as well as beliefs in human control of environment issues and formal and informal flow of information [ 17 ]. Community perceptions and practices of health risks related to drinking water are associated with drinking water, the persistence of these health problems and the level of awareness of the problem. Perception of the need for quality water drives the need to practice activities at the source, during transportation or storage and handling practices that will ensure the safety and quality of water as well as the use and storage of this God given resource [ 18 ]. Water quality concerns like water scarcity, lack of awareness and knowledge of ’safe’ collection, handling and storage of water, inadequate sanitation services and/or unhygienic practices exist in communities. In addition; water quality attributes like taste, colour, smell, litter and presence of feacal matter in and around the water source as well as education, age, number of years a person has lived in the community, presence of visible aspects of water pollution and water source catchment area encroachment influence community members’ perception on the quality and safety of drinking water [ 19 ]. These water quality concerns when left unresolved for long may lead to community perceptions of health risk and prompt community practices that may be dangerous to their health like use of chemicals or using alternative sources of water such as unprotected open wells, use of unprotected buckets left outside on the ground [ 20 ]. Through a dialogue with government, drinking water service providers, and community members’ perceptions of the quality of drinking water and associated health benefits and risks inform community practices to maintain water quality [ 11 ]. Understanding community beliefs and behaviours is critical for water resource management, monitoring, and creating drinking water quality standards [ 11 ]. Anecdotal evidence reveals that the quality and safety of drinking water in Mbarara city do not meet World Health Organization criteria for drinking water quality. Thus, the purpose of this study was to explore community members’ perceptions and practices about the quality and safety of drinking water. Results of this study provides community members’ perceptions, practices and perceived solutions to improve and maintain safe and quality drinking water in Mbarara City, South Western Uganda.

Materials and methods

Ethics statement.

Administrative clearance was obtained from District, city, parish, National water and sewerage cooperation and Ministry of water, lands and Environment authorities. The protocol was reviewed and approved by Mbarara University of Science and Technology Institutional Review Committee (MUST-2021-39), and National Council of Science and Technology (HS1469ES). Permission was obtained from the district, local council leaders and household heads especially for water harvest tanks before commencement of data collection. Written informed consent was obtained from every participant before participating in the interviews and discussions.

This study was conducted in Mbarara city, south western Uganda. Mbarara city is the commercial and administrative capital of Mbarara district in south western Uganda. Mbarara city is located 270 kilometres, by road, southwest of the capital city, Kampala. Mbarara district lies between coordinates 00 36 48 S, 30 39 30 E and covers an area of 1,778.4 square kilometres. It has a population of 91867 [ 21 ]. Mbarara city receives an average annual rainfall of 1200 mm with two rainy seasons during the months of September-December and February-May. Temperature ranges between 17°C to 30°C, humidity of 80–90%. The topography is a mixture of fairly rolling and sharp hills and mountains, shallow valleys and flat land. Mbarara city is provided, operated and maintained with safe water supply technologies and sanitation facilities to all communities of the city. Mbarara district recorded an increase in access to safe and clean water from 45% in 2000 to about 63% in the villages and 65% for the municipality in 2007. The safe water coverage is 65.9% in the rural areas and 95.7% in the urban, while accessibility to safe water lies between 29% and 95% [ 22 ].

Participant recruitment and description

This study was a cross sectional study employing qualitative techniques. Purposive sampling was employed to recruit participants for the key informant interviews and focus group discussions. Four (4) key informants were recruited from the District water office, National Environment Management Authority (NEMA), Ministry of Water, Lands and environment and National water and sewerage cooperation (NWSC) based their knowledge, expertise and experience with water safety and quality in Mbarara city. The key informants were water quality control managers and policy makers. Eighty- four (84) community members from six (6) villages/cells (Kaburangiire, Nyarubanga, Rubiri, Lugazi, Katebe and Katukuru) of Mbarara city were recruited for focus group discussions (FGDs). FGDs participants were residents of the selected villages who were consumers of the water from various water sources. Evidence has shown that people who reside and work near water sources are more likely to be concerned about the quality and safety of drinking water [ 23 ]. Both male and females across the different age groups that met the inclusion criteria of being community members in the six selected villages or water service providers in Mbarara city irrespective of their gender and socio economic status were recruited to gain a diversity of perceptive and variability with in the community. We did not collect information on the years of residency. We assumed that persons who had lived in the neighborhood for a longer period of time were better knowledgeable about the safety and quality of water in Mbarara. The participants in the Focus Group Discussions were chosen by the local chairman of the village. The six focus group discussions were constituted by senior inhabitants of the neighborhood who owned homes and had lived in those homes with their families for a long time, also known as "abataka," which literally means "permanent residents of the village."

Data collection

Local leaders as gatekeepers to the community were used to recruit FGD participants and fix dates and time for the discussions. Written informed consent was obtained from all research participants. The consent forms, focus group discussion and Key Informant interview guides were translated into Runyankore-Rukiga the language spoken and well understood in the study area. Discussion / Interview guides were used to collect data from key informants and FGDs between May and June 2022. The key study questions included: 1. What is your perception of the quality and safety of drinking water from sources in your community. 2. In your own view, who/what do you think is responsible for the quality and safety of drinking water you have described? 4. At family and community level, what has been done to ensure that drinking water in your community is of quality and is safe? 5. At family, community level, district/ as stakeholders what you done to ensure quality and safety of drinking water from drinking water sources in the community? These questions were elaborated on with more probing questions. AC conducted the interviews together with NP as a note taker and AT did the recording of the interviews and discussion. Each focus group was comprised of 14 participants. Extra effort was made to ensure an equal number of males and females constituted the focus group discussions.

The interviews and focus group discussions with the participants were conducted at a private location at the convenience of the different participants at the time agreed upon with the study team. The interviews were recorded with a Sony audio recorder and field notes were taken. Participants were not paid for participating in the study but time was compensated as was stipulated in the consent form. The interviews lasted between 60 and 90 minutes. The interviews were transcribed and those in Runyankole-Rukiga translated into English and back translated to Runyankole-Rukiga to ensure that what was recorded in Runyankole-Rukiga is what was captured in the English version of the transcript. Interview data was supplemented with field notes captured during the different interview and discussion sessions. One interview/ focus group discussions was conducted per day.

Data analysis and interpretations

Data analysis started with listening to the audio recordings alongside the field notes at the end of each day’s interview/ discussion session. They were transcribed sequentially on the daily basis by CA, NP and OJ which helped in giving a deeper insight into the inquiry during the data collection process in line with the study objectives. The data was transcribed by Research Assistant [ 24 ] and checked by CA and OJ. Data analysis was done through different stages of familiarization with data and dual coding was employed. CA, OJ and ACD independently read through the transcripts and identified emerging themes and manually identified corresponding quotes by highlighting them with different colors per theme. Data management from interviews and focus group discussions were analyzed differently and merged in one codebook by incorporating data from audio recordings, verbatim notes and nonverbal observations during the interview and discussion processes. A codebook with sections for parent themes, sub themes, description and illustrative quotes was developed from emerging themes. Using the four predetermined themes, indicative thematic analysis was done by analyzing statements from participants, identifying commonalities and developing sub themes. The same data was entered into Atlas Ti 7.5. Using the themes, each transcript was re-analyzed to reveal the best corresponding quotes. The same process was done for key informant interviews and focus group discussions data.

Findings from this study reveal the community perceptions and practices of community members and stakeholders on the quality of drinking water in Mbarara city, south western Uganda. The results are from Four (4) key informant interviews and six Focus Group Discussions from stakeholders and community members in Mbarara city. A total of 28 males and 56 females constituted the interviews and discussions. Participant quotes are presented to support the findings. Four themes were identified, Community perceptions on the quality and safety of drinking water, factors responsible for the quality of drinking water, community perceived solution for safe and quality drinking water and community practices for safe and quality drinking water as well as several subthemes as shown in Table 1 .

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https://doi.org/10.1371/journal.pwat.0000075.t001

Community member’s perception on the quality and safety of drinking water from sources in their community

We explored community members’ perceptions on the quality and safety of drinking water in selected villages in Mbarara city. We asked the community members about their perception on the quality and safety of their drinking water from the different drinking water sources in their villages. They gave a wide range of perceptions regarding the different drinking water sources. Generally, they indicated that the drinking water from different drinking water sources is not good, dirty and tasted salty. They believe that the quality is generally lacking since it is contaminated with human waste, cow dung, always changes in colour, it sediments on settling and the water sources are communally used and shared in some cases shared with animals. The supply on taps is unpredictable while boreholes suffer serious mechanical problems and are usually out of use and for some long period of time.

To be honest, our water is bad since we share it with animals, dumping cow dung in it, and we also use it for cooking and bathing and the problem is that we do not know which water is fit for consumption and how it looks like because we think good water is pure white, which you may discover is not actually good, so we do not know which one is good and we cannot avoid water from the well even taps are few and used by a small number of people; most of us go to the well (FGD II). We have a borehole, but the water cannot be used for cooking or bathing. Nothing good comes from that borehole, unless you wish to mix the soil for making bricks. Even when you wash your hands, they turn black. So in Kaburangire, we have a water problem, and even the rust they mentioned is there, so that is the type of water we have, and the borehole is now not operational ( FGD III ).

Similarly, a participant was noted to have said:

The safety and quality of drinking water is not all that bad because we follow world health drinking water standard regulations, but at times you find that the sources are contaminated when you are not aware, and we can face a challenge because this water that passes underground can be contaminated with anything, let us talk about boreholes, even a tap. Knowing that taps are sometimes passing through sewerage areas, someone can cut it and start getting water back flow ( KII IV ).

In addition, to the poor quality of drinking water, the participants reported that the supply is not constant

It comes and goes, and when it returns, it is different from what we had before it disappeared, and even when you put it in your mouth, you can feel the difference, and later, when it settles, a lot of sediments appear, which raises the concern on the quality (FGD IV).

Community member’s perceived factors responsible for the quality and safety of water in their community

Communities attribute the poor quality and safety of drinking water from sources in their communities to the growing population in the city.

Mbarara’s population is growing rapidly because, as a new city, there is scramble for resources. There are a lot of issues and of course as national water, we cannot meet the demands at the moment and people are opting for other sources (KII I). Because of the rising population, garbage is deposited everywhere, rendering our water unfit for human consumption (FGD IV).

There is a lot of garbage volume and residents live in congested homesteads with no provision for waste disposal. They resort to throwing their waste in River Rwizi at night.

Waste management is poor, and everyone dumps wherever they please; laws are in place, but they are not followed; personnel exist to execute laws, but when you try to do what is right, they will claim that you are interfering with voters ( KII II ). Sometimes you see someone on a boda boda (motorcycle) and you think that he is carrying luggage, and for those of us who walk at night, he reaches the bridge and stops for a while and dumps garbage into the river, thus we live by God’s grace. For example, someone may have garbage in the house and when she wakes up in the morning, she goes with it and throws it in the river because she has nowhere to put it, but those ditches will undoubtedly help us, so in your research, you should coordinate with the government to put emphasis on landlords digging up ditches for their tenants ( FGD I ).

The toilet facilities are few and unhygienic making residents to resort to other options like open defecation, using polythene bags and plastic bottles for their excreta which is dumped /poured in the garbage bins or trenches. Some landlords open their toilets to empty directly in River Rwizi.

We have seen that pollution is from domestic wastes, people opening their latrines anyhow, so everything ends up in the system, which means you cannot rule out the drainage system, so we simply urge people to connect to national water because we know it is safe (KII I).

Participants believe that national water and sewerage cooperation is not treating the water they supply for use or does not treat the water properly. They believe that sometimes they use poor quality chemicals which remain as residues in the water as it is supplied.

You go to get water and find that it is really River Rwizi water that is very brown in color and I don’t know what causes that because I believe they treat it and how come it is dirty as if it was not treated and even after boiling it and putting it down to settle, you find those brown things on the bottom so that water is not good and those who drink it without boiling it will get sick (FGD VI).

Other participants noted that drinking water is treated before it is availed for use but however attributed the poor quality of water accessed to the location of the consumer.

People who live in valleys have a higher chance of receiving dirty water because that is where settlement takes place and everything settles where there is a valley and you find that people who are in valleys have issues with water so the people at the end have a higher chance of receiving dirty water but we always put mitigation measures, for example, we encourage regular flashing of our systems. There are planned sessions every three months sometimes we conduct unplanned system flashing, which is done after getting complaints ( KII III ).

Participants believe that the safety and quality of drinking water is affected by poor maintenance of water systems. Once the water gets to the individual consumers, the overhead tanks are dirty since they are never or rarely cleaned. National water and sewerage cooperation is using old dysfunctional water systems (pipes) that have never been changed from the time they were installed and sometimes lack enough chemicals for treatment.

They are also not cleaning their tanks on a regular basis. Sincerely speaking, people do not wash their tanks for 3–4 years, the tank is just there, there are lizards, bird droppings, monkeys playing on it, and people are unaware of its effect, but people keep saying that national water gives us bad water because people are not sensitized, this is because our duty ends at your tap beyond your tap, it is your responsibility ( KII III ). We have ancient pipes. I believe these pipes are 72 years old, making them incredibly old, and you can detect water pollution from those old pipes since they wear out over time. We might not recognize if the problem has occurred, but with this next project, we are replacing all of them ( KII III ).

Participants reported a deficiency in city planning. Most buildings are not built according to city authorities’ plan. Factories and industries are constructed in water catchment areas with no permits and a provision for their waste disposal hence ending up in dumping their waste inappropriately that ends up in water catchment areas and water sources. These illegal developments are hard to regulate and monitor because of political interference.

We will not evict a factory near the river because there are so many industries along this river here, and when we look at the analysis we have been doing, we find that some samples taken at night have a different water quality than those taken during the day because we suspect that a lot of things are dumped there at night ( KII III ). We no longer listen to technical experts; instead, we listen to politicians, which is driving our people to regress to the early 1960s. Let us prevent political involvement, and since there is a political hand somewhere, people construct factories anywhere even in water catchment areas, making it difficult for us to intervene. Hence, we consider our integrity, I believe there is much we can avoid ( KII II ).

River Rwizi which is the main source of drinking water in Mbarara city has been covered by water hyacinth. The weed has covered the biggest part of the river, it has led to reduction in water volume, it traps garbage deposited in the river and makes pumping of water for treatment hard and costly.

This weed in the River Rwizi called water hyacinth, it collects and traps polythene bags and bottles, and their contents slowly leak into the water, thus I believe they are to blame for the polluted water we drink these days, and you may find that some individuals use it the way it is ( FGD I ).

Community member’s practices for safe and quality drinking water

Water rationing is employed where some areas receive water at night while others during the day to make sure that at least all communities have water per day. Communities are encouraged to have overhead tanks to ensure a continuous supply of water.

We practice water rationing, in which we decide to give water to one zone during the day and another during the night. We make sure everyone has access to water. We encourage people to get overhead tanks because residents in Mbarara get water via direct lines, so if there is no water on a certain day, overhead tanks might be of help ( KII III ).

Participants revealed that there are laws in place to ensure water catchment areas are protected and not encroached on for human activities. Any developments along water catchment areas must be evaluated for impact assessment and must receive permission inform of permits that clearly stipulates what activity is going to take place and for how long and their waste disposal and environment protection and conservation plan.

We have legislation in place, such as the National Environmental Act, which serves as a foundation for all environmental concerns, including the preservation of all water resources. We have national wetland, river bank, and lake shores management in place for the preservation of water sources, and as part of our mandate, we aim to engage communities and stakeholders in the conservation of water sources, and the battle is still ongoing ( KII IV ). Surface water abstraction permit, ground water abstraction permit, water discharge permit, construction permit, there are quite a few and for surface water permit, the main idea is that issuing a permit is to ensure that water is available for all not just some because they all need water so if we allow individuals, and you know individuals are selfish by nature, one can decide to take all the water excluding others so one needs to tell our department based on what they want ( KII I ).

Participants revealed that National water and Sewerage Corporation engages in both internal and external quality control measures to ensure that the drinking water supplied for human consumption is safe and of quality.

We sample together and then discuss the results. They also audit, and now we are going to audit so that if one group is not speaking the truth, another group will. I believe that with that level of transparency, we can perform those system checks and, at the end of the day, compare the data ( KII III ).

Community members have put in place security controls around water sources, the water sources are faced to stop animals from drinking from sources meant to supply drinking water for human consumption, they encourage community members not to send young children to fetch water hence minimising defecating and swimming in drinking water sources.

We have attempted to secure the water in our wetland so that when children go to get water from there, they do not defecate in the area surrounding our water and that cows that go to our water source do not go close the water that we fetch for drinking, which is what we do with our wetland. We make sure that when someone fetches, she/he ensures that the tap is properly closed and that children do not go there to play on the borehole/tap so that we can protect it ( FGD III ).

Water service providers ensure that drinking water supplied for use by communities is treated and is safe and of recommended quality of drinking water for supply to communities. The communities boil the water, sieve it, cover it, use clean water collection vessels, allow it to sediment, and use the supernatant and sometimes use safeguard to treat their drinking water before use.

For safety, I believe that for national water and sewerage cooperation, safety is maintained through treatment to address specific issues such as microbiology nuclei and all that, as well as disinfection, so the water is disinfected, and then there is the aspect of filtration to remove these other suspended materials, so there is this deliberate effort to treat the water so that it meets the standards that we require. So there is an effort in terms of personnel and resources, and the entire site has the idea in mind that this water must be treated to this acceptable standard, so the safety is guaranteed (KII IV) . We boil water, especially when it comes to drinking, and then we filter it to limit the level of contamination since after boiling, there is some dirt that remains on the bottom ( FGD II ).

Communities have a vast number of alternative sources of drinking water that range from, open wells, protected springs, boreholes, gravity flow, and tap water and rain harvest tanks. They use an alternative source depending on what they want to use the water for and the availability, accessibility, safety and quality of water.

We can choose to utilize rain water since we have been spoiled by taps, and as a result, one can build a house without a gutter. Collecting rain water would also help, but the problem is that once collected, one person dips a cup to fetch water and another person brings a jug, making it unsafe, but it would be one of the best ways because that water is free, and I feel like if I could get a crest tank and put it on my house to harvest clean water, could it be a solution and once I get it, I get period to wash it and by the time water enters into that tank I make sure there is a sieve to prevent large things from entering the tank, and once the water is finished, you cleanse the tank and boil water from that tank for drinking ( FGD II ).

Community members have resorted to putting to use the overgrowing garbage and plastic volume to use. Garbage and plastics are being collected and used to make brickets. Plastics are collected and recycled into other accessories like beads and mats.

Organic and inorganic plastics are separated for possible recycling since we cannot do away with this because as a country, we still need jobs, so how can we have these jobs without damaging the environment and River Rwizi ( FGD II ). For example , we make bricks from garbage , so if a person is aware that garbage is important and will benefit from it , he or she will take responsibility , and the responsible companies will come and pick it up . However , people should also be aware of which rubbish has value so that one knows the exact amount he is likely to receive ( FGD VI ) .

Community member’s perceived solutions to ensure safe and quality of water

Participants believe that engaging stakeholders in the catchment area on water source protection guidelines and the need to alert communities/stakeholders in case of contamination, and enforcing laws through political leaders can help ensure safe and quality water to the communities.

When the catchment is not proper, all of these will come down, so when we go to individuals, we must be aware that when certain things are not done correctly, one suffers, and when someone is not aware that chemicals for agriculture once sprayed, such chemicals will come back to me, so those people are not aware. So that is the information we are talking about, the safety of water and how this safety is important to all of us, not just you and me, but all of us, and even the people outside there, because otherwise, we would be treating the symptoms rather than the core cause of the problem ( KII I ).

Participants believe that community sensitisation on the need for safe and quality drinking water will help greatly in changing the mind set of communities.

Sensitization, that is it, the community may not be aware of pollutants rods and, major contaminants of water, so they need to come up with an approach of sensitization in our communities about the dangers of drinking contaminated water by informing the communities that if you use contaminated water, it affects them like getting water borne diseases, so that they can come to understand that they must protect the water sources (KII I). When you go to the villages in these town councils, you will see what I mean, you will see everywhere is garbage and so on, so sometimes we apply law and sometimes you can find a leader in the village does not have a latrine, does not have anything to use for sanitation, you find somebody’s compound is full of funny things and is a leader, so those are the things, but we will keep on community sensitization. Even if we lack resources, we will continue to educate the community, and those who wish to spread the word will go out and improve their surroundings ( FGD II ).

There is need to educate communities to create awareness and ensure that there are buffer zones in water catchment areas.

Awareness has been raised through educating communities and limiting development around waterways. NEMA regulates all projects where it is not possible; NEMA has not authorized any developments beside water resources, and when they are permitted, limitations are imposed. When we look at the River Rwizi, we tried to engage a number of stakeholders, including encroachers along the river basins, so that they can vacate and the buffer is well protected, and when the buffer is well protected, it means that the water is fine. We have also engaged industrialists in managing the effluents coming from their industries, so that the water released from the manufacturing processes is treated before it is discharged into the river, and even before it is discharged into the river ( KII IV ).

Participants believe that following guidelines set to ensure safe and quality drinking water is key to in maintaining safe and quality drinking water.

We must adhere to the drinking water guidelines. What is the distance from the latrine to the water source, sometimes people come and start cultivating near the water sources, so some meters are required from the water source, and even the water source itself has some meters’ standard like 50 by 50 so that if there is run off, it should not filtrate easily into the water source, so after putting the measures at the source, we know that that source is ok ( KII II ).

Participants believe that most factors that affect the safety and quality of water in Mbarara city are due to the behaviour and mind set of community members. National water and sewerage cooperation tries its level best to supply safe and quality drinking water at the recommended standard for home use not at the bottled water standard. Most communities access this resource through illegal connections that makes the cost of supply and maintenance expensive for the service provider thereby making it expensive for the consumer. Communities are aware that the water available for use needs to be boiled before drinking it but for personal reasons like lack of firewood, ignorance and time, they resort to drinking it half boiled or unboiled. City authorities have put in place provisions for waste disposal but communities continue to dispose waste as they wish.

We have a lot of pollution from industrial developments, as well as problems with improper waste management, all of which end in our waters. Leaving that aside, we have a number of illegal construction and illegal activities that are taking place outside of the 100-meter zone that is the protection zone along the river, thus ending up in the river, so the quality of water is not up to date due to poor waste disposal, population growth, and direct influent discharge from industries that is not even treated, and all of that ends up in our water sources ( KII IV ). Individuals illegally connect to the water supply, and we have many such incidents in Mbarara, largely from private plumbers. Connection is also important since someone will connect you where the settlement is and where they do not encourage consumers to be connected, but you will find individuals connecting illegally ( KI III ). We would be boiling the water, but most of the time we do not have enough money to buy charcoal because it is expensive, and sometimes you can have food but you cannot cook because you do not have charcoal, so there is no charcoal to boil water, so most people drink it without boiling it, which has caused typhoid infections. People have been talking about someone who just grabs a cup, pours directly from a jerrican, and drinks ( FGD I ).

To ensure safe and quality drinking water, there is need for collaboration between communities and water service providers. The community needs to be engaged and encouraged to participate in activities aimed at ensuring stable and sustainable supply and use of safe and quality drinking water. There is need to set up community water committees, catchment management committees and school sanitation committees through which information pertaining the use and maintenance of safe and quality water and practices to ensure proper use and maintenance of safe and quality water are shared between communities and water service providers.

we normally have the water user committees to check whoever gets water but they also have a challenge themselves. There is need to make committee on sanitation to ensure things like toilets, hand washing facility, abcd are introduced in the community so that they can reduce the risks and if someone comes from the toilet, there should be a jerrican and soap on the toilet to wash hands so those are the measures we are putting up but I told you that is a behavioural change strategy with its many challenges ( K II IV ). We have not gone to the household level, but we have managed to get to catchment organizations, which are made up of many stakeholders, including local governments, so from local governments, we establish a committee of that catchment organization called the catchment management committee. The organization is comprised of structures that comprise the executive arm, which meets to address issues. There are many entities in that catchment management committee, such as district local government, which brings on board district water officials, chief administrative officers, and LC 5 (Local council) chairpersons ( KII I ).

Participants believe treating drinking water from drinking water sources in Mbarara city at supply system level with chemicals and at home with safeguard will greatly help in improving the quality and safety. This could be by providing chemicals to help in home treatment of drinking water and general treatment of water before it is supplied for use on the taps. There is need to mechanically remove the water weeds/plants, clear bushes around water sources and regularly cleaning the open wells.

Water, in my opinion, should be collected in tanks and then purified at various treatment stations before being released. But my heart continues telling me that maybe National Water and Sewerage Corporation obtains water from a source and store it in tanks, but they don’t treat it before distributing it, or the tanks aren’t washed on a regular basis, or the treatment they use is insufficient. You are aware that in Uganda, less treatment can be used than is recommended, which cannot be sufficient for effective water treatment (FGD II). For safety, I believe that national water and sewerage cooperation maintains safety through water treatment to address specific issues such as microbiological nuclei. Water is disinfected, and there is also the issue of filtration to remove these other suspended things, so there is a concerted effort to clean the water so that it meets the acceptable standards we require. There is constant monitoring to verify that these criteria are met, including the availability of persons and resources to ensure that this water is treated to appropriate levels and that safety is ensured ( KII I ).

Participants suggest that water service providers should ensure that the water they supply is safe and of quality. They should put provisions in place to ensure that the quality is maintained throughout the supply chain by routine monitoring and surveillance and ensuring that any pitfalls are addressed in a timely manner.

I believe that National Water and Sewerage Company should take the time to walk around and observe what is going on, not only to appear to collect their money but also to learn about the kind of water they supply. There is a need for communities to set aside time to meet with individuals and discuss what to do, like we are doing now, and we also know if the problem is here or there. They do not have that time they only come when they want their money but I think giving time to people is also crucial. They should visit different locations since the water may be polluted in some locations but clean in others ( FGD II ).

Participants believe that so many factors contribute to ensuring safe and quality drinking water supply. It is these same factors if not properly addressed that will lead to deterioration of water quality. By engaging stakeholders, it is a great step towards provision and sustaining clean, safe and quality water. Stakeholders should provide community with feasible solutions, keep the process in check and hence the safety and quality of drinking water is achieved and maintained.

We are executing a project in Rubanda, Kabale, Ntungamo, and Rukiga where they are attempting to engage with people to preserve water in their farmland in order to maintain it for a longer period of time. But when it is running, it runs a way with soil and they see that some diseases are becoming prevalent and they start asking themselves that they never used to get these diseases so where are they coming from not knowing that it is due to mishandling some aspects of the environment such as hormonal birth control measures and when we shared those things they understood ( KII I ). We have national wetland, river bank, lake beaches management in place for water source protection, and as part of our mandate, we attempt to engage communities and stakeholders in water source conservation and protection, and the struggle is still ongoing ( KII III ).

This study explored community perceptions and practices about drinking water quality and safety from various water sources in Mbarara, Uganda. We wanted to know what community members thought about the quality of water drawn from drinking water sources, what is responsible for the quality, what they do to ensure the drinking water is safe and of good quality, and what possible solutions there are to ensure the water is safe and of good quality. The findings show that populations in Mbarara, south western Uganda, regard the quality of drinking water drawn for use as poor, dirty, tastes salty, and is generally unsafe for human use, as well as being limited in supply to communities.

Community member’s perceptions of the quality and safety of drinking water

Based on the color, taste, and presence of physical pollutants, community members perceive the safety and quality of drinking water to be poor, dirty, and salty. This perspective was echoed by members of the community and key informants. They believe that the safety and quality of drinking water is poor and that it does not meet established standards for human consumption, yet they continue to consume it since it is the only water available to them. Similarly, a study by Apecu and co-authors on quality of water sources in South-western Uganda using the compartment bag test (CBT) found out that most of the water sources in the study areas were not fit for human consumption without prior treatment [ 25 ]. This is odd given that this is a city neighbourhood where social services should be of higher quality. This however is not unique to Mbarara city alone since the World Health Organization estimates that 2 billion people lack safely managed services, including 1.2 billion with basic services, 282 million with limited services, 367 million using unimproved sources, and 122 million drinking surface water, when the United Nations Sustainable Development Goal6 is to ensure universal access to water and sanitation by 2030 [ 26 ]. In addition, without point-of-use treatment systems, at least four billion people worldwide do not have access to clean drinking water or are under the impression that it is unsafe to drink [ 27 ]. This is owing to increased water demand, reduced water supplies, and increased water pollution as a result of tremendous population and economic expansion. In many underdeveloped nations’ urban areas, badly polluted little water sources are widely used [ 28 ]. Contamination concerns are considerable in urban areas due to increased population. Yet, because most populations in urban areas cannot afford the expense of a treated water system and lack access to infrastructure, their sense of quality relies on modest water systems or various sources to supply their drinking water demands [ 29 ]. In addition, perceptions of worsening water quality have been observed all across the world, in both rich and developing nations, and ’Thousands have survived without love, not one without decent water quality [ 30 ]. It should be emphasized that the types, magnitudes, and extents of water quality concerns vary from country to country, and even from region to region within a country. This might be the result of uneven growth, accessibility, and water demands. Issues may be resolved via trust, political will, and social will, albeit the methods vary depending on the region of the country. It should be noted that; trust enables water delivery businesses to achieve both social and commercial benefits [ 31 ].

Community member’s perceived factors responsible for safety and quality of water

According to the findings of this study, the poor drinking water quality in Mbarara city is mostly attributable to improper waste management, poor water treatment, poor system maintenance, political interference, population increase, and water hyacinth. Some variables do not remain constant throughout time. These factors are not static, but instead vary over time. Some of these factors are human made while others are beyond the communities’ control. Issues such as flooding and water cost fluctuate between wet and dry seasons; changes in the water supply; changes in the community’s/family’s ability to maintain quality, household income, and level of awareness within a given community [ 32 ]. Similarly, to our study, the decline in water quality is caused by increased demand for water, reduced water supplies, and increased water pollution as a result of dramatic population and economic growth [ 33 ]. This is due to the discharge of essential pollutants from anthropogenic activities such as industrial applications (solid/liquid wastes, chemical compounds, mining activities, spills, and leaks), urban development (municipal wastes, land use practices, and others), and agricultural practices (pesticides and fertilizers) that affect the safety and quality of water in urban communities [ 34 ]. There are other key pollutants emitted by natural processes that contribute to climate change, natural catastrophes, geological causes, soil matrix, and hyporheic exchange in the aquatic environment, all of which might have a detrimental impact (e.g. Endocrine disruptions, DNA damage, cancerogenicity). These elements, together with rising temperatures, accelerated remobilisation processes, and hormone pollution, have a greater impact and may disrupt natural environmental equilibrium. It should be noted that, as indicated in this study, greater population expansion frequently coincides with the demand for more food and food production, forcing communities to encroach on water catchment areas for agriculture [ 35 ]. Because of the requirement for improved yields on a short plot of land, fertilizers and crop insecticides are used indiscriminately. These changes in land-use/land-cover (LULC) pattern degrade water quality. This is due to the interdependence of population and economic growth, as well as water consumption, resources, and pollution, all of which contribute to water shortage [ 36 ]. Moreover, population growth leads to deforestation to support agricultural development and urban expansion in Mbarara city, necessitating the need for water quality protection to meet urgent human requirements while also ensuring the long-term quality of water resources. There is a lot of garbage produced in the midst of economic issues, making it hard to properly dispose of or pay for proper disposal through structured public services, resulting in waste buildup. Occasionally garbage is dumped in available water sources or catchment areas. This not only affects the quality of drinking water, but it also raises the cost of treated water since more sophisticated procedures are used to assure that the water supplied to communities is treated and of the required standard. A study to investigate the impact of drinking water quality and sanitation on child health: Evidence from rural Ethiopia demonstrated that uncontaminated stored drinking water and safe child stool disposal are related with 18 and 20 percentage point decreases in child diarrhoea rates, respectively [ 37 ].

To ensure that drinking water from sources in Mbarara city is safe and of quality for use, as well as available and accessible in quantity, service providers use a holistic approach, water rationing, changing chemicals as often as possible depending on the quality of water available for treatment, and the water treatment process is quality controlled internally at National Water and Sewerage Corporation facility treatment centers and externally at Uganda National Bureau of Standards. National environment Management Authority issues permits for any developments that would result in waste to be dumped in River Rwizi or any developments close to the water catchment areas. This can be traced to the fact that, National water and sewerage cooperation, through their service accelerated program has created awareness for the need and maintenance of safe and quality water through radio talk shows, school health sanitation program and in churches. The communities, on the other hand, ensure that bushes are cleared around water sources, that adults and children in company of adults have access to these sources, that overhead tanks are installed and maintained, and that drinking water is boiled. This is crucial in increasing the availability, accessibility, and appropriate quantity of quality and safe drinking water since they are a primary measure for preventing different water-borne infections, poisoning, disease outbreaks, and human deaths in urban settings [ 38 ]. A healthy population is critical for health and long-term socioeconomic growth. Clean drinking water is a crucial component of Primary health care and plays an important role in poverty alleviation, hence boosting economic growth [ 24 ]. Due to the exponential growth in water demand and the decrease in usable freshwater due to various climate, environmental, and anthropogenic events, rain water harvesting has become a useful practice because it is inexpensive and low risk if the roof catchment, collection system, and storage are well maintained [ 39 ]. Similar to the findings of this study, there is a need to better understand social factors such as governance and increased understanding of diverse physical and social influences that lead to a more comprehensive understanding, knowledge, and need for clean, safe, and quality water, as well as water security, which is defined as a reliable and adequate supply of safe and quality water to support humans and ecosystems at all times [ 40 ]. Furthermore, there is a need to raise awareness about the need of clean, safe, and high-quality drinking water, as well as the necessity for other government stakeholders to work together to enhance water quality for improved health [ 41 ]. As a result, there should be a continuous extensive water quality monitoring program of drinking water sources across urban areas and their adjacent settings to guarantee population health and environmental balance [ 42 ]. However, this requires policymakers and managers to use Artificial Neural Networks (ANNs) and risk analysis techniques to predict water quality because such predictions indicate the level of risk (low, moderate, or high) to the inhabitants, allowing for the implementation of preventive measures to avoid illness or disease outbreaks. This can be achieved through engaging in socio-hydrological research and data analysis to help improve the current understanding and management of the quantity and quality society dynamics for drinking water quality and safety [ 40 ].

Community member’s perceived solutions for safe and quality of water

The participants in this study feel that stakeholder involvement, community awareness, establishing catchment plan rules and regulations, water treatment and maintenance, surveillance, and monitoring might all assist to improve and maintain the quality and safety of drinking water in Mbarara. This is due to an increasing number of people turning to alternative sources of drinking water, such as rainwater harvesting, to reduce their environmental footprint, because rainwater harvesting (RWH), while not economically feasible, provides protection against damage caused by increasing precipitation frequency and intensity [ 43 ]. Similarly, Anjana and colleagues in India advocated training people on drinking water treatment methods, sanitation, and hand washing habits since participants believed their drinking water was pure and didn’t need any further treatment [ 44 ]. Furthermore, an Ochilova and colleagues study recommended the need for rational use and protection of water resources, as well as ensuring and guaranteeing citizens’ right to a favorable natural environment, as well as helping to protect land, subsoil, forests, flora and fauna, atmospheric air, natural resources, and improving healthy family life [ 45 ]. There is a need to connect rural and urban areas. The two communities are mutually reliant. Water streams come from rural communities to feed water to urban cities; food production is mostly done in rural communities but is consumed in both rural and urban areas. The rural people should be given policy attention to the ecosystem services that rural areas provide, and the rural area’s ecology should be conserved for long-term service delivery, reducing the need to farm in water catchment areas that exist in already overcrowded urban areas [ 46 ]. Most importantly, there is a need to invest in implementing sustainable technologies for future water supply and sanitation because the amount of time and money spent by developed, developing, and underdeveloped countries on water investments, operation, and maintenance has changed dramatically in recent decades [ 47 ].

Strengths and limitations of the study

The findings of this study represent the perspectives and opinions of community members and stakeholders in Mbarara City’s water provision and maintenance. The study’s main strength is the unanimity in their thoughts and beliefs. Our capacity to interact with communities and stakeholders in water service supply to investigate their perceptions and practices about the safety and quality of drinking water is our strength. Key informants in this study were water service providers; this may have worked against us since they were afraid to completely voice their ideas and opinions for fear of acting against the expectations of their employers. Nonetheless, we ensured all of our participants of anonymity and confidentiality during the informed consent procedure. We acknowledge that this study presents views and opinions of communities and stakeholders in the water service provision and maintenance in Mbarara city.

Residents in Mbarara perceive the quality of drinking water drawn for use as not good, dirty and salty, and generally unfit for human consumption and limited in supply to communities. Increased population expansion and accompanying human activities, political intervention, flooding, and deficiencies in water treatment, supply, and management are all contributing to poor quality of drinking water in Mbarara city. The service providers use water rationing, offer permits for developments in the city and most importantly in water catchment areas, the water is treated and the water supply system is quality controlled both internally and externally, water sources are protected from contamination by clearing bushes and fencing, and alternative sources are used to supply drinking water in the event of suspected contamination.

Perspective and recommendation

We recommend a comprehensive approach to the provision, use, and management of drinking water sources. Policymakers and stakeholders should collaborate to increase knowledge, sensitization, and practices aimed at providing, using, and maintaining safe and high-quality drinking water from drinking water sources in Mbarara, south-western Uganda.

Acknowledgments

We thank all those who participated in this research project. We acknowledge the study participants and the Alex Tumusiime (AT) and Patience Nabaasa the study Research Assistants and Owokuhaisa Judith(OJ) who read through the transcripts and coded We acknowledge the reviewers who are going to review and provide constructive comments that will help perfect this manuscript.

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Clean Water

Clean and safe water is essential for good health. how did access change over time where do people lack access.

Access to clean water is one of our most basic human needs.

But, one in four people in the world do not have access to safe drinking water. This is a major health risk. Unsafe water is responsible for more than a million deaths each year.

In this article, we look at data on access to safe water and its implications for health worldwide.

Unsafe water is a leading risk factor for death

Unsafe water sources are responsible for over one million deaths each year.

Unsafe water is one of the world's largest health and environmental problems – particularly for the poorest in the world .

The Global Burden of Disease is a major global study on the causes and risk factors for death and disease published in the medical journal The Lancet . These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here.

Lack of access to safe water sources is a leading risk factor for infectious diseases, including cholera, diarrhea , dysentery, hepatitis A, typhoid, and polio . 1 It also exacerbates malnutrition and, in particular, childhood stunting . In the chart, we see that it ranks as a very important risk factor for death globally.

The global distribution of deaths from unsafe water

In low-income countries, unsafe water sources account for a significant share of deaths.

Globally, unsafe water sources account for a few percent of deaths.

In low-income countries, it accounts for around twice as many deaths .

In the map here, we see the share of annual deaths attributed to unsafe water across the world.

When we compare the share of deaths attributed to unsafe water either over time or between countries, we are not only comparing the extent of water access but its severity in the context of other risk factors for death. Clean water's share depends not only on how many die prematurely from it but also on what else people are dying from and how this is changing.

Death rates are much higher in low-income countries

Death rates from unsafe water sources give us an accurate comparison of differences in mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing.

In this map, we see death rates from unsafe water sources across the world. Death rates measure the number of deaths per 100,000 people in a given country or region.

What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 people.

Compare this with death rates across high-income countries: across Europe, rates are below 0.1 deaths per 100,000. That’s a greater than 1000-fold difference.

The issue of unsafe water sources is, therefore, one that is largely limited to low- and lower-middle-income countries.

We see this relationship clearly when we plot death rates versus income, as shown  here . There is a strong negative relationship: death rates decline as countries get richer.

Access to safe drinking water

What share of people have access to safe drinking water.

Sustainable Development Goal (SDG) Target 6.1 is to: “achieve universal and equitable access to safe and affordable drinking water for all” by 2030.

Almost three-quarters of the world's population uses to a safely managed water source . One in four people does not use a safe drinking water source.

In the next chart, we see the breakdown of drinking water use globally and across regions and income groups. We see that in countries with the lowest incomes, less than one-third of the population uses safely managed water. Most live in Sub-Saharan Africa.

The world has made progress in recent years. Unfortunately, this has been very slow. In 2015 (at the start of the SDGs), around 70% of the global population had safe drinking water. This has slowly increased over recent years.

If progress continues at these slow rates, we will not reach the target of universal equitable access to safe and affordable drinking water by 2030.

In the map shown, we see the share of people across the world using safe drinking water facilities.

How many people do not have access to safe drinking water?

In the map shown, we see the number of people across the world who do not use safe drinking water facilities.

Improved water sources

What share of people do not use an improved water source.

The definition of an improved drinking water source is: “...those that have the potential to deliver safe water by nature of their design and construction, and include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water.” Note that usage of drinking water from an improved source does not ensure that the water is safe or adequate, as these characteristics are not tested at the time of the survey. However, improved drinking water technologies are more likely than those characterized as unimproved to provide safe drinking water and to prevent contact with human excreta.

In the map shown, we see the share of people across the world who do not use improved water sources.

In the map shown, we see the number of people across the world who do not use an improved water source.

What determines levels of clean water usage?

Usage of improved water sources increases with income.

The visualization shows the relationship between usage of improved water sources versus gross domestic product (GDP) per capita. We see that there is a general link between income and improved water source usage.

Typically, most countries with greater than 90% of households with improved water have an average GDP per capita of more than $10,000 to 15,000. Those at lower incomes tend to have a larger share of the population without access.

Although income is an important determinant, the range of levels of usage that occur across countries of similar prosperity further supports the suggestion that there are other important governance and infrastructural factors that contribute.

Rural households often lag behind in improved water usage

In addition to the large inequalities in improved water usage between countries, there can also be large differences within countries. In the charts, we plotted the share of the urban versus rural population with usage of improved water sources and safely managed drinking water, respectively. Here, we have also shown a line of parity; if a country lies along this line, then access in rural and urban areas is equal.

Since nearly all points lie above this line, with very few exceptions, usage of improved water sources is greater in urban areas relative to rural populations. This may be partly attributed to an income effect; urbanization is a trend strongly related to  economic growth. 2

The infrastructural challenges of developing municipal water networks in rural areas are also likely to play an important role in lower usage levels relative to urbanized populations.

Definitions

Improved water source : "Improved drinking water sources are those that have the potential to deliver safe water by nature of their design and construction, and include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water"

Usage of drinking water from an improved source does not ensure that the water is safe or adequate, as these characteristics are not tested at the time of the survey. However, improved drinking water technologies are more likely than those characterized as unimproved to provide safe drinking water and prevent contact with human excrement.

Safely managed drinking water: "Safely managed drinking water" is defined as an "Improved source located on premises, available when needed, and free from microbiological and priority chemical contamination."

'Basic' drinking water source: an "Improved source within 30 minutes round trip collection time."

'Limited' drinking water source: "Improved source over 30 minutes round trip collection time."

' Unimproved' drinking water source: "Unimproved source that does not protect against contamination."

'No service': access to surface water only.

WHO (2023) – Fact sheet – Sanitation. Updated September 2023. Online here .

Spence, M., Annez, P. C., & Buckley, R. M. (2009).  Urbanization and growth: commission on growth and development . Available online .

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Essay on Drinking Water

Students are often asked to write an essay on Drinking Water in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Drinking Water

Importance of drinking water.

Water is life’s essential ingredient. Our bodies are about 60% water. Drinking water keeps us hydrated, which is vital for our bodily functions.

Benefits of Drinking Water

Drinking water aids in digestion, nutrient absorption, and maintains body temperature. It also helps in flushing out toxins and keeps our skin healthy.

How Much Water to Drink?

Experts suggest drinking 8-10 glasses of water daily. However, this can vary based on physical activity and climate.

Drinking water is crucial for our health. So, let’s make a habit of consuming enough every day.

Also check:

• Advantages and Disadvantages of Drinking Water

250 Words Essay on Drinking Water

The importance of drinking water.

Water is a fundamental element of life. Covering about 70% of the Earth’s surface, it’s also the primary component of the human body. However, the importance of drinking water extends beyond mere existence. It plays a vital role in our physical and mental health, and even in societal development.

Physiological Benefits

Water is the medium of all metabolic processes in the body. It aids in digestion, nutrient absorption, and waste elimination. It regulates body temperature, lubricates joints, and maintains skin health. Dehydration, on the other hand, can lead to fatigue, headaches, and impaired cognitive function.

Mental Health Implications

The brain is approximately 75% water. Hence, adequate hydration is necessary for optimal brain function. Studies suggest that even mild dehydration can affect mood, concentration, and memory. Furthermore, it can exacerbate symptoms of certain mental disorders.

Societal Relevance

Access to clean drinking water is a global concern. It’s not just about health, but also about social equality and economic growth. Water scarcity can lead to conflicts and migration, while waterborne diseases can cripple communities.

In essence, drinking water is not just a basic need, but a cornerstone of human health and societal progress. As we delve deeper into the intricacies of our bodies and societies, the importance of this clear, tasteless liquid becomes even more apparent. We must therefore strive for its conservation and equitable distribution, recognizing it as a critical component of our collective wellbeing.

500 Words Essay on Drinking Water

Introduction.

Water is the essence of life, a fundamental element for all living organisms on Earth. The significance of drinking water cannot be overstated. It is a critical component of our diet, directly linked to our health and wellbeing. This essay will delve into the importance of drinking water, its health benefits, the challenges of water scarcity, and the need for sustainable management of this vital resource.

Water makes up about 60% of the human body, highlighting its role in maintaining bodily functions. It aids in digestion, nutrient absorption, and waste elimination. It also helps regulate body temperature, lubricate joints, and protect sensitive tissues. Dehydration, or the lack of adequate water in the body, can lead to serious health issues such as kidney stones, urinary tract infections, and even cognitive impairment.

Health Benefits of Drinking Water

Drinking sufficient water has numerous health benefits. It boosts skin health and beauty, flushing out toxins and promoting a clear complexion. It aids in weight loss by enhancing metabolism and suppressing appetite. Furthermore, it plays a crucial role in maintaining cardiovascular health by facilitating the flow of oxygen and nutrients in the blood.

Challenges of Water Scarcity

Despite the critical role of water, it is a scarce resource for many. According to the World Health Organization, nearly 2.2 billion people worldwide lack access to safely managed drinking water services. Water scarcity can lead to a range of health issues, including malnutrition and waterborne diseases. It also exacerbates socio-economic disparities, as the poor and marginalized are often the most affected by water scarcity.

Sustainable Water Management

Given the importance and scarcity of water, sustainable water management is imperative. It involves the efficient use of water resources, reducing waste, and promoting conservation. For instance, rainwater harvesting and wastewater treatment can provide alternative sources of water. Additionally, awareness campaigns can educate the public about the importance of water conservation and the dire consequences of wastage.

In conclusion, drinking water is a fundamental human need and a critical component of our health and wellbeing. However, water scarcity is a pressing issue that threatens our ability to meet this basic need. Therefore, it is crucial to prioritize sustainable water management, promoting water conservation, and ensuring equitable access to clean, safe drinking water for all. By doing so, we can safeguard our health and secure a sustainable future for generations to come.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on Clean Water and Sanitation
• Essay on Challenges of Clean Water and Their Solutions
• Essay on Bottled Water

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• Open access
• Published: 22 June 2021

The widespread and unjust drinking water and clean water crisis in the United States

• J. Tom Mueller   ORCID: orcid.org/0000-0001-6223-4505 1 &
• Stephen Gasteyer 2  

Nature Communications volume  12 , Article number:  3544 ( 2021 ) Cite this article

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• Water resources

An Addendum to this article was published on 13 June 2023

An Author Correction to this article was published on 13 June 2023

Many households in the United States face issues of incomplete plumbing and poor water quality. Prior scholarship on this issue has focused on one dimension of water hardship at a time, leaving the full picture incomplete. Here we begin to complete this picture by documenting incomplete plumbing and poor drinking water quality for the entire United States, as well as poor wastewater quality for the 39 states and territories where data is reliable. In doing so, we find evidence of a regionally-clustered, socially unequal household water crisis. Using data from the American Community Survey and the Environmental Protection Agency, we show there are 489,836 households lacking complete plumbing, 1,165 community water systems in Safe Drinking Water Act Serious Violation, and 9,457 Clean Water Act permittees in Significant Noncompliance. Further, elevated levels of water hardship are associated with rurality, poverty, indigeneity, education, and age—representing a nationwide environmental injustice.

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Introduction.

Both in and out of the country, most presume that residents of the United States live with close to universal access to potable water and sanitation. The United Nations Sustainable Development Goals Tracker, which tracks progress toward meeting Sustainable Development Goal Number 6—calling for universal access to potable water and sanitation for all by 2030—estimates that 99.2% of the US population has continuous access to potable water and 88.9% has access to sanitation 1 . By percentages and the lived experience of most Americans, this appears accurate. The American Community Survey shows that from 2014 to 2018 only an estimated 0.41% of occupied US households lacked access to complete plumbing—meaning access to hot and cold water, a sink with a faucet, and a bath or shower. Although this relative percentage may be low, this 0.41% corresponds to 489,836 households spread unevenly across the country, making the absolute number quite troubling. These numbers become even more dramatic when we broaden our scope to poor household water quality, where the estimates we provide in this paper show the issue affects a far greater share of the population (Table  1 ).

This study builds on a growing body of evidence showing access to plumbing, water quality, and basic sanitation are lacking for a disturbingly large number of US residents by providing a definitive picture of the ongoing household water crisis in the United States. Water and sanitation issues have been a growing concern in the United States, particularly among policy organizations, for the past 20 years 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 . For example, the now-dated Still Living without the Basics report used Census data from 2000 to show that more than 670,000 households (0.64% of households and 1.7 million people) lacked access to complete plumbing facilities 7 . Further, the Water Infrastructure Network published a report in 2004 citing a gap of $23 billion between available funding and needed water and sanitation infrastructure investments 6 . In line with this, the American Society of Civil Engineers has repeatedly given the United States a “D” grade for water infrastructure, and “D-” for wastewater infrastructure in their annual “Infrastructure Report Card” 11 . Although water hardship in the United States has experienced some academic attention, much of the work has become dated and has generally focused on a single dimension of the issue at a time—for example, recent scholarship has focused on exclusively incomplete plumbing 3 , 4 , 9 , water quality 5 , 10 , or on only urban parts of the country 2 . This has left our understanding of the scope of the issue incomplete. In this paper, we estimate and map the full scope of water hardship for the dimensions of incomplete plumbing and poor drinking water quality across the entire United States, while also estimating and mapping the scope of poor wastewater quality for the 39 states where EPA data is reliable, in order to complete this picture.

Prior work from academics and policy groups on dimensions of water hardship has found water access issues pattern along common social inequalities in the United States. The Natural Resources Defense Council released a report demonstrating the disproportionate impact on people of color posed by Safe Drinking Water and Clean Water Act regulatory burdens 12 , which built on similar peer reviewed findings 13 , 14 . Furthermore, both policy papers and peer reviewed studies have analyzed Census data to estimate the population lacking access to complete plumbing facilities and clean water 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 12 . The studies suggest low-income and non-White people—particularly indigenous populations who continue to face injustices related to legacies of settler colonialism 15 —are significantly more likely to have incomplete plumbing and unclean water 3 , 12 . Further, it appears incomplete plumbing may be a disproportionately rural issue, while poor water quality may be a disproportionately urban issue 5 , 9 . Direct comparisons, as we perform here, are needed to fully establish the variability of this inequality between dimensions of water hardship.

The prior scholarship on the inequitable distribution of plumbing and pollution speaks to the well-documented environmental injustices found throughout the United States. Environmental injustice, meaning the absence of “fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies” (p. 558) 16 , has been documented in the United States along the social dimensions of income 17 , 18 , poverty 19 , race and ethnicity 20 , 21 , age 22 , education 22 , 23 , and rurality 22 , 24 , 25 . Based on the evidence of prior work on water hardship, it is clear household water access represents an ongoing environmental injustice in the United States 5 . However, the specific dimensions of this injustice, and how they vary between type of water hardship remain largely unknown. To address this gap, we estimate models of water injustice for the previously identified social dimensions at the county level for elevated levels of both incomplete plumbing and poor water quality.

Level of water hardship in the United States

Based upon the most recent available data reported by both the United States Census Bureau via the American Community Survey and the Environmental Protection Agency via Enforcement and Compliance History Online, we find that incomplete plumbing and poor water quality affects millions of Americans as of 2014–2018 and August 2020, respectively (Table  1 ) 26 , 27 . A total of 0.41% of households, or 489,836 households, lacked complete plumbing from 2014–2018 in the United States. Further, 509 counties, representing over 13 million Americans, have an elevated level of the issue where >1% of household do not have complete indoor plumbing (Table  2 ). Thus, even if individuals are not experiencing the issue themselves, they may live in a community where incomplete plumbing is a serious issue.

The portion of the population affected by poor water quality is much greater than that of incomplete plumbing. Poor water quality in our analysis is indicated in two ways, (1) Safe Drinking Water Act Serious Violators and (2) Clean Water Act Significant Noncompliance. For the first, community water systems are regulated under the Safe Drinking Water Act and are scored based on their violation and compliance history, those community water systems that are the most problematic are recorded as Serious Violators by the Environmental Protection Agency 27 . Second, any facility that discharges directly into waters in the United States is issued a Clean Water Act permit. Those which “hold a more severe level of environmental threat” are ruled as being in Significant Noncompliance 27 . Importantly, although data on Safe Drinking Water Act Serious Violators is available nationwide, the Clean Water Act data reported by the EPA is known to be inaccurate for 13 states. Thus, although we can draw national conclusions for incomplete plumbing and Safe Drinking Water Act violations, our understanding of Clean Water Act violations is limited to the 39 states and territories for which data are available and reliable.

Using these two measures of poor water quality, we find 2.44% of community water systems, a total of 1165, were Safe Drinking Water Act Serious Violators and 3.37% of Clean Water Act permittees in the 39 states and territories with accurate data (see Methods for more details), a total of 9457, were in Significant Noncompliance as of 18 August 2020. At the county level, this corresponds to an average of 2.86% of county community water systems being listed as Safe Drinking Water Act Significant Violators and an average of 6.23% of county Clean Water Act permittees being listed as Significant Noncompliers. Due to limitations in the data, we are unable to determine exactly how many individuals are linked to each problematic community water system or Clean Water Act permittee, however, we do find that over 81 million Americans live in counties where >1% of community water systems are listed as Significant Violators, and more than 153 million Americans in the 39 reliable states and territories live in counties where greater than one percent of Clean Water Act permittees are Significant Noncompliers. Thus, although the number of individuals impacted by these issues is certainly far smaller than these totals, a vast number of Americans live in communities where issues of water quality are elevated.

Due to our conservative approach of removing all states with Clean Water Act data issues, we test the sensitivity of our estimates by also calculating supplemental estimates of Clean Water Act Significant Noncompliance under two counterfactual scenarios. In the first, we include the data as-is from the EPA for all counties in the 50 states, DC, and Puerto Rico, and in the second, we duplicate the counties in the top and bottom 20% of Significant Noncompliance in states without data issues—with the rationale being that the 945 counties removed due to poor data represented roughly 40% of the total counties remaining when problems states were removed. Thus, this attempts to simulate total counts if those removed were balanced between very high and very low levels of noncompliance. Results using all EPA data increase national estimates of Significant Noncompliance (Tables 3 and 4 ), with the total percent of permittees in this status jumping from 3.37% to 6.01%. While the duplication test does raise our estimates, it is not nearly as dramatic, with the percent of permittees in Significant Noncompliance only rising to 3.87%. These results make sense given that the most common reason for data issues was an overreporting of noncompliance within states.

When looking at the issue spatially, we can see that while water hardship affects all parts of the country to some degree, the issues are clustered in space (Figs.  1 – 3 ). Importantly, the clustering varies between each water issue. Incomplete plumbing is clustered in the Four Corners, Alaska, Puerto Rico, the borderlands of Texas, and parts of Appalachia (Fig.  1 ); Safe Drinking Water Act Serious Violators are clustered in Appalachia, New Mexico, Alaska, Puerto Rico, and the Northern Intermountain West (Fig.  2 ); and Clean Water Act Significant Noncompliance clearly follows state boundaries—likely speaking to variable monitoring by state. Although spatial representation is limited by the absence of 13 states with inaccurate EPA data, we can still see that Clean Water Act Significant Noncompliance is clustered in the Intermountain West, the Upper Midwest, Appalachia, and the lower Mississippi (Fig. 3 ). These regional clusters persist when we include the problem states, which is visible in the map included in the Supplemental Information (Supplementary Figure 1 ).

Households are determined to have incomplete plumbing if they do not have access to hot and cold water, a sink with a faucet, a bath or shower, and—up until 2016—a flush toilet.

Safe Drinking Water Act Serious Violators are those community water systems regarded by the Environmental Protection Agency as the most problematic due to violation and compliance history.

All facilities that discharge directly into water of the United States are issued a Clean Water Act permit, those who represent a more severe level of environmental threat due to violations and noncompliance are considered in Significant Noncompliance.

Water injustice modeling

Although we can easily see clustering by space in Figs.  1 through 3 , the maps do not tell us whether or not incomplete plumbing and poor water quality are also clustered by social dimensions, which would represent an environmental injustice. To assess this social clustering, we estimate linear probability models of elevated levels of incomplete plumbing and poor water quality with the previously identified environmental justice dimensions of age, income, poverty, race, ethnicity, education, and rurality as our independent variables. We include these independent variables due to their prevalence within prior work on environmental injustice in both rural and urban areas 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 . Further, although there is not a one-to-one overlap, these variables conceptually map onto the dimensions of the Center for Disease Control Social Vulnerability Index: Socioeconomic Status (i.e. income, poverty, education), Household Composition & Disability (i.e. age), Minority Status & Language (i.e. race and ethnicity), and Housing & Transportation (i.e. rurality) 28 .

For each outcome, we first estimate purely descriptive models with only one dimension of injustice included at a time, and then estimate a full model with all dimensions included. The outcomes are dichotomous measures of whether or not a county had >1% of households with incomplete plumbing, >1% of community water systems listed as Serious Violators, or >1% of Clean Water Act permittees in Significant Noncompliance. All descriptive statistics for the dichotomous outcomes are presented in Table 2 . Descriptive statistics for the continuous independent variables are presented in Supplementary Information (Supplementary Table  1 ). Here we present the outcomes of the purely descriptive models visually in Fig.  4 and discuss the full models in the narrative. Full regression results, including exact 95% confidence intervals and p -values, for all models are available in Supplementary Information (Supplementary Tables  2 , 3 and 4 ).

Different colors for plotted coefficients represent separate blocks of variables. Models are linear probability models with state fixed effects and cluster-robust standard errors at the state level. All tests two-tailed. Dots indicate point estimates and lines represent 95% confidence intervals. Models predicted elevated levels of each dimension of water hardship. For incomplete plumbing this is indicated by >1% of households in a county having incomplete plumbing ( N  = 3219). For Safe Drinking Water Act (SDWA) Serious Violation this is indicated by >1% of active community water systems being considered Serious Violators ( N  = 3143). For Clean Water Act (CWA) Significant Non-Compliance this is indicated by >1% of Clean Water Act permittees being considered in Significant Non-Compliance ( N  = 2261). Full model results, confidence intervals, and exact p -values available in SI.

We find elevated levels of incomplete plumbing at the county level were significantly ( p  < 0.05) associated with older populations, lower income, higher poverty, greater portions of indigenous people (American Indian, Alaska Natives, Native Hawaiian, and Other Pacific Islanders), lower levels of education, and more rural counties (Fig.  4 ). A great deal of these associations persisted in a full model with all dimensions of injustice (Supplementary Table  2 ). The only differences between the full model and the series of purely descriptive models were that income, percent with at least a bachelor’s degree, and non-metropolitan metropolitan adjacency were no longer significantly associated with elevated levels of incomplete plumbing. This indicates that the inequalities in plumbing access along the dimensions of age, poverty, indigeneity, low education, and extreme rurality persist at the county level, even when accounting for the other dimensions of environmental injustice.

The models for elevated levels of Safe Drinking Water Act Serious Violators indicated less social inequality than the models for incomplete plumbing. The purely descriptive models found elevated levels of Serious Violators were associated with higher income, higher poverty, and metropolitan counties (Fig.  4 ). The full model had minor variation, with median household income no longer being significant in the model (Supplementary Table  3 ). Thus, the full model shows that the association between elevated levels of Serious Violators and higher poverty and metropolitan status persists even when considering other social dimensions.

We see the fewest indicators of water injustice for elevated levels of Clean Water Act Significant Noncompliance—which only include counties within the 39 states and territories with accurate data. In the purely descriptive models, we find older populations, more Latino/a counties, less educated counties, and remote rural counties were significant less likely to have elevated levels of noncompliance (Fig. 4 ). In the full model, the association for education is no longer significant but age, Latino/a, and rurality remain (Supplementary Table 4 ). Similar to our national estimates, we also conducted model sensitivity tests using the same scenarios described above. As shown in Fig. 5 , neither scenario substantively changes our conclusions, with the only changes in significance being for percent Latino/a and percent without a high school diploma—both of which were only marginally significant in our primary models ( p  > 0.01).

Descriptive regression model results. Different colors for plotted coefficients represent separate blocks of variables. Models are linear probability models with state fixed effects and Huber/White/Sandwich cluster-robust standard errors at the state level. All tests are two-tailed. Dots indicate point estimates and lines represent 95% confidence intervals. Models predicted whether or not there were greater than 1% of Clean Water Act permittees being considered in Significant Noncompliance in the county. First model excludes counties in states with CWA data issues ( N  = 2261), second model includes all counties reported by the EPA ( N  = 3206), third model duplicates counties in the top and bottom 10% of CWA Significant Noncompliance within states without data issues ( N  = 3151). Full model results, confidence intervals, and exact p values available in SI.

Our findings demonstrate that the problem of water hardship in the United States is hidden, but not rare. Indeed, millions live in counties where more than 1 out of 100 occupied households lack complete plumbing. Millions more live in places with chronic Safe Drinking Water Act violations and Clean Water Act noncompliance. We present this paper to help sound the alarm of this significant household water crisis in the United States. Although the relative share of Americans experiencing this problem is low, the absolute number of people dealing with incomplete plumbing—a total of 489,836 households—and poor water quality—1165 community water systems nationwide and 9457 Clean Water Act permittees in the 39 accurate states and territories—remains quite high. Further, given the water infrastructure of the United States, consistently deemed as poor by experts 6 , 11 , if action is not taken the situation may only get worse.

These findings are even more concerning when considering that water hardship is spread unevenly across both space and society, reflecting the spatial patterning of social inequality due to settler colonialism, racism, and economic inequality in the United States. Figures  1 , 2 , and 3 document the clear regional clustering of these issues and our models of environmental injustice demonstrate the social inequalities found for this form of hardship. Particularly in the case of incomplete plumbing, we find significant environmental injustice at the county level along the social dimensions of age, income, poverty, indigeneity, education, and rurality. These associations certainly stem from multiple causal pathways—for example associations with indigeneity likely stem from legacies of injustice as well as ongoing policies placing limitations on land use and infrastructure development on American Indian reservations 15 . Remedying these injustices will require careful attention to the root causes of the problem. It is important to note that the signs of injustice for poor water quality were less clear than for incomplete plumbing, with far fewer significant associations. Further, the minimal support for injustice in the case of Clean Water Act Significant Noncompliance was evident in all three specifications of counties in our sensitivity tests. Suggesting that the removal of the states with data issues did little to impact coefficient estimates. These differences between dimensions of water hardship highlight the nuance between each of these specific forms of water hardship, and suggest a one-size-fits-all approach to remedying this crisis is unlikely to be effective. This need for place-based policy is made stark when we view the obvious state level differences in Clean Water Act Significant Noncompliance in Fig. 3 . A clear direction for future work is to investigate the cause of these notable state-level differences.

The household water access and quality crisis we have identified here is solvable. Policy is needed to specifically address these issues and bring this problem into the spotlight. However, as indicated by the persistently high levels of Safe Drinking Water Act Serious Violation and Clean Water Act Significant Noncompliance, any policy put in place must be enforceable and strong. As it currently stands, counties with elevated levels of incomplete plumbing and poor water quality in America—which are variously likely to be more indigenous, less educated, older, and poorer—are continuing to slip through the cracks.

Data sources

Data for this analysis were extracted from the American Community Survey (ACS) 5-year estimates for 2014–2018 via Integrated Public Use Microdata Series – National Historic Geographic information System (IPUMS-NHGIS) 26 , and from the Environmental Protection Agency’s (EPA) Enforcement and Compliance History Online (ECHO) Exporter 27 . Data were extracted at the county level for all 50 states, Washington DC, and Puerto Rico–the two non-state entities with available data. The ACS is an ongoing survey of the United States which documents a wide variety of social statistics ranging from simple population counts to housing characteristics. Due to the staggered sampling structure of the ACS, it takes 5 years for every county to be sampled. Because of this, researchers must use 5-year intervals to ensure complete data coverage. The data from these 5 years are projected into estimates for all counties in the United States for the 5-year period in question. As of this study, 2014–2018 was the most recently available data.

ECHO collates data from EPA-regulated facilities across the United States of America to report compliance, violation, and penalty information for all facilities for the most recent 5-year interval. ECHO data is updated weekly and the data for this paper was extracted on 18 August 2020. This means that the data in our analysis represents the status of each community water system or Clean Water Act permittee, as reported by the EPA, as of 18 August 2020. Only those community water systems or Clean Water Act permittees listed as Active by ECHO were included in this analysis. As ECHO data is at the level of the water system, permittee, or utility, we aggregated data up to the county level.

Safe Drinking Water Act data was geolocated using QGIS 3.10 based upon latitude and longitude. This was done because other geographic identifiers for the Safe Drinking Water Act data were often missing. In line with prior work 4 , 5 , 7 , 8 , and in order to facilitate a cleaner dataset, we only focus on those water systems labeled community water systems for our analysis. Community water systems were geolocated based upon the county in which their latitude and longitude were located, if a community water system had latitude and longitude over water, a nearest neighbor join was used. In total, 1334 out of 49,479 community water systems were dropped because of there being no reported latitude or longitude. Of these, a total of 4.0%, or 54 community waters systems, were reported as in serious violation. It should be noted that the EPA is aware of a small number of water systems in Washington for which ECHO data may be inaccurate. However, since this is a small number and it is not listed as a ‘Primary Data Alert,’ we retain all states in this portion of the analysis. Finally, the EPA is generally aware that there are “inaccuracies and underreporting of some data in this system,” which is listed as a Primary Data Alert 27 . However, due to the lack of specifics, we cannot exclude inaccurate cases. Thus, our analysis should be viewed as reflecting drinking water quality is as reported by the EPA in August of 2020, which may reflect some level of inaccuracy.

Active Clean Water Act permittees were first identified by listed county. This was done because 345,176 out of 350,476 permittees had a county reported. Those without a county reported were located using latitude and longitude in the same manner as community water systems. There were 10 permittees without latitude and longitude or county listed which were excluded from our analysis. Of these, seven were in significant noncompliance and three were not. Due to some Clean Water Act permittees having latitude and longitude placements far away from the United States, those over 100 km from their nearest county were excluded from analysis. Unfortunately, ECHO data for the Clean Water Act data during the study period is inaccurate for 13 states. Although the nature of the inaccuracy varies from state to state, these issues generally stem from difficulties in transferring state data into the federal system. Due to this, these states appear to have far more permittees in Significant Noncompliance than are actually in violation. To address this issue, we removed all counties within these states from our Clean Water Act analysis. The impacted states include Iowa, Kansas, Michigan, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, Vermont, Washington, West Virginia, Wisconsin, and Wyoming 29 . Finally, for community water systems and Clean Water Act permittees, some counties (76 for community water systems and 5 for Clean Water Act permittees) had no reported cases. Those counties were treated as zeroes for cartography and as missing for modeling purposes.

Similar to prior work in this area 4 , 5 , 8 , we restrict our analysis to the scale of the county for reasons related to data limitations and resulting conceptual validity. Although counties are arguably larger in geographic area than ideal for an environmental injustice analysis, if we were to use a smaller unit for which data is available such as the census tract, the conceptual validity of the analysis would be limited due to the apolitical nature of these units. As outlined above, ECHO data is messy and missing many geographic identifiers. What is provided is generally either the county or latitude and longitude. If only the county is provided, then we are constrained to using the county regardless of conceptual validity. However, even when latitude and longitude are provided—which is the case for many observations—the provided point location says nothing about which households the water system or permittee serves or impacts. Due to this, whatever geographic unit we use carries the assumption that those in the unit could be plausibly impacted by the water system or permittee. Given that counties are often responsible for both regulating drinking water, as well as maintaining and providing water infrastructure 30 , we were comfortable with this assumption between point location and presumed spatial impact when using the scale of the county. However, we believe this assumption would have been invalid and untestable for smaller apolitical units for which demographic data is available such as census tracts.

Beyond the issues presented by ECHO data, the county is also the appropriate scale of analysis for this study due to the estimate-based nature of the ACS. ACS estimates are based on a rolling 5-year sample structure and often have very large margins of error. At the census tract level, these standard errors can be massive, especially in rural areas 31 , 32 , 33 . Due to this variation, and the need to include all rural areas in this analysis, the county, where the margins of error are considerably smaller, is the appropriate unit for this study. All of this said, the county is, in fact, a larger unit than often desired or used in environmental justice studies. Studies focused on exclusively urban areas with clearer pathways of impact can and should use smaller units such as census tracts. It will be imperative for future scholarship focused on water hardship across the rural-urban continuum to gain access to reliable data on sub-county political units, as well as data linking water systems to users, to continue documenting and pushing for water justice.

Dependent variables

The dependent variables for this analysis were assessed in both a continuous and dichotomous format. For descriptive results and mapping, continuous measures were used. For models of water injustice, a dichotomous measure which classified counties as either having low levels of the specific water issue or elevated levels of the specific water issue, was used due to the low relative frequency of water access and quality issues relative to the whole United States population. For all three outcomes, we benchmark an elevated level of the issue as what would be viewed as an unacceptable level under United Nations Sustainable Development Goal 6.1, which states, “by 2030 achieve universal and equitable access to safe and affordable drinking water for all” 1 . As this goal focuses on ensuring all people have safe water, we deem a county as having an elevated level of the issue if >1% of households, community water systems, or permittees had incomplete plumbing, were in Significant Violation, or Significant Noncompliance, respectively. Although we could have used an even stricter threshold given the SDG’s emphasis on ensuring access for all people, we use 1% as our cut-off due to its nominal value and ease of interpretation.

For water access, the continuous measure was the percent of households in a county with incomplete household plumbing as reported by the ACS. The ACS currently asks respondents if they have access to hot and cold water, a sink with a faucet, and a bath or shower. Up until 2016, the question also included a flush toilet 34 . As we must use the most recent 2014–2018 5-year estimates to establish full coverage of all counties, this means that incomplete plumbing in this item may, or may not include a flush toilet depending on when the specific county was sampled. The dichotomous version of this variable benchmarked elevated levels of incomplete plumbing as whether or not 1% or more of households in a county had incomplete plumbing.

Water quality was assessed via both community water systems from the Safe Drinking Water Act, and from permit data via the Clean Water Act. For Safe Drinking Water Act data, the continuous measure was the percent of community water systems within a county classified as a Safe Drinking Water Act Serious Violator at time of data extraction. The EPA assigns point values of either 1, 5, or 10 based upon the severity of violations of the Safe Drinking Water Act. A Serious Violator is one who has “an aggregate score of at least eleven points as a result of some combination of: unresolved more serious violations (such as maximum contaminant level violations related to acute contaminants), multiple violations (health-based, monitoring and reporting, public notification and/or other violations), and/or continuing violations” 27 . The dichotomous measure benchmarked elevated rates of Safe Drinking Water Act Significant Violation as whether or not >1% of county community water systems were classified as Serious Violators.

For Clean Water Act permit data, the continuous measure was the percent of permit holders listed as in Significant Noncompliance at the time of data extraction. Significant Noncompliance in the Clean Water Act refers to those permit holders who may pose a “more severe level of environmental threat” and is based upon both pollution levels and reporting compliance 27 . The dichotomous measure again set the threshold for elevated levels of poor water quality at whether or not >1% of Clean Water Act permittees in a county were listed as in Significant Noncompliance at time of data extraction.

Independent variables

The independent variables we include in models of water injustice are those frequently shown to be related to environmental injustice in the United States. These include age, income, poverty, race, ethnicity, education, and rurality 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 . Age was included as median age. Income was included as median household income. Poverty was the poverty rate of the county as determined by the official poverty measure of the United States 35 . Race and ethnicity was included as percent non-Latino/a Black, percent non-Latino/a indigenous, and percent Latino/a. Because the focus was on indigeneity, percent American Indian or Alaska Native was collapsed with Native Hawaiian or Other Pacific Islander. We did not include percent non-Latino/a white due to issues of multicollinearity. Finally, rurality was included as a three-category county indicator of metropolitan, non-metropolitan metropolitan-adjacent, and non-metropolitan remote, as determined by the Office of Management and Budget in 2010 36 . The OMB determines a county is metropolitan if it has a core urban area of 50,000 or more people, or is connected to a core metropolitan county by a 25% or greater share of commuting 36 . A non-metropolitan county is simply any county not classified as metropolitan. Non-metropolitan metropolitan adjacent counties are those which immediately border a metropolitan county, and non-metropolitan remote counties are those that do not.

Water injustice modeling approach

Water injustice was assessed by estimating linear probability models for the three dichotomous outcome variables with state fixed effects to control for the visible state level heterogeneity and differences in policy, reporting, and enforcement (e.g. the clear state boundary effects in Fig.  3 ). We employ the conventional Huber/White/Sandwich cluster-robust standard errors at the state level—which account for heteroskedasticity while also producing a consistent standard error estimate in-light of the lack of independence found between counties in the same state. All modeling was performed in Stata 16.0 and mapping was performed in QGIS 3.10. We assessed all full models for multicollinearity via condition index and VIF values and the independent variables had an acceptable condition index of 5.48 for incomplete plumbing and Safe Drinking Water Act models and 5.63 for Clean Water Act models, well below the conservative cut-off of 15, as well as VIF values of <10. We initially included percent non-Latino/a white as an independent variable, but removed the item due to unacceptably high condition index levels (>20). All indications of statistical significance are at the p  < 0.05 level and 95% confidence intervals and exact p -values of all estimates are provided in Supplementary Information. Each dependent variable was analyzed through a series of six models. First, we estimated separate purely descriptive models, where the only independent variables included were those associated with that specific dimension and the state fixed effects, for all five dimensions of environmental injustice. After estimating these five models, we estimated a full model including all social dimensions at once.

The reason for this approach was to ensure that we provided a robust descriptive understanding of the on-the-ground social patterns of water hardship, in addition to a full model showing the strongest social correlates of this issue. For example, if when we only included income variables we found that incomplete plumbing is less likely in counties with higher median incomes, but this effect goes away when we include other social variables, this does not remove the fact that there is an unequal distribution of incomplete plumbing by income on-the-ground. All that it means is that this income effect does not persist over and above the other social dimensions of environmental injustice. It may be that once other dimensions such as structural racism, captured by race and ethnicity variables, are considered, income is no longer a significant predictor. However, at a pure associational level, incomplete plumbing would still be unequally distributed by income on-the-ground. In fact, this is exactly what we find for incomplete plumbing (Supplementary Table  2 ). Due to this, both the pure descriptive and full models are needed for full understanding. Complete tables of all results are presented in the Supplementary Information File (Supplementary Tables  1 through 4 ).

Sensitivity tests

Due to our conservative approach to remove all problem states from the Clean Water Act portion of our analysis, we conducted a series of sensitivity tests wherein we generated national estimates of Significant Noncompliance, as well as models of elevated Significant Noncompliance under two scenarios (Supplementary Tables 5 and 6 ). In the first scenario we include all data reported by the EPA, meaning that we use all data for the 50 states, DC, and Puerto Rico, regardless of any EPA data flags. In the second scenario, we replaced the data lost when dropping states by duplicating the counties in the top and bottom 20% of significant violations in the remaining counties. The top and bottom 20% was chosen because the 945 counties removed when the 13 states were dropped was roughly equal to 40% of the remaining 2262 counties. This counterfactual allows us to get closer to a plausible estimate of the absolute scope of CWA Significant Noncompliance by adopting a scenario where the counties dropped in problem states were either very high, or very low in terms of Significant Noncompliance. Functionally, duplicating the bottom 20% posed a challenge because the bottom 30% of counties had zero permittees in Significant Noncompliance. This zero-bias is one of the primary reasons why our outcome variable was dichotomized. To address this, we randomly selected two-thirds of these counties for duplication using a seeded pseudorandom number generator in Stata. Following duplication of cases, all estimates and models were generated in the same manner as the primary models of this study.

Reporting summary

Further information on research design is available in the  Nature Research Reporting Summary linked to this article.

Data availability

The raw and geolocated datasets are publicly available on the Open Science Framework project for this study at https://doi.org/10.17605/OSF.IO/ZPQR9 ( https://osf.io/zpqr9/ ).

Code availability

Analysis code is available on the Open Science Framework project for this study at https://doi.org/10.17605/OSF.IO/ZPQR9 ( https://osf.io/zpqr9/ ). As the raw data was not geolocated using a code-based operation, code for this portion of the analysis is not available. However, the raw data is posted, and should researchers wish they will be able to use our description provided here to replicate geolocation using the GIS software of their choice. All other elements of the analysis are easily replicated via our provided code. As the both the raw and geolocated datasets are provided, replication of our analysis should be straightforward.

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Acknowledgements

The authors would like to acknowledge Tom Dietz, Lauren Mullenbach, Matthew Brooks, and Jan Beecher for their feedback on this manuscript. They would also like to thank Colleen Keltz at the Washington State Department of Ecology for alerting us to the issues with Clean Water Act data for Washington and other states.

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Mueller, J.T., Gasteyer, S. The widespread and unjust drinking water and clean water crisis in the United States. Nat Commun 12 , 3544 (2021). https://doi.org/10.1038/s41467-021-23898-z

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Essay on Water for Students and Children

500+ words essay on water.

Water is one of the most important substances for life on earth to function. It is equally important for humans as well as animals. Water does not merely help us survive, but it is significant for our day to day functioning. It has numerous uses when we come to think about it. Majority of our earth is covered with water itself, but, not all of it is safe for consumption. Therefore, it makes it essential for us to utilize this transparent substance chemical wisely. Moreover, if we look at the shortage of water happening in our country, it makes it all the more important to conserve it immediately.

Uses of Water

As we have already said that water has numerous uses, we will see where it is used. This part will most importantly help us realize the importance of water . It will make humans aware of what absence of water in the following areas can do to human life. As India’s main occupation is agriculture, water is exhaustively used here. Irrigation and cattle rearing requires a lot of water. Thus, a lot of farmers’ livelihood depends on it.

Further, industries use water for various purposes. It comes in handy when cooling, manufacturing and transporting several goods. For instance, thermal power plants consume quite a substantial amount of water for their running.

Furthermore, the domestic use of water cannot be left behind. In the day to day life of the common man, water plays a vital role. That is to say, from drinking water to washing utensils, we need water every step of the way.

After that, plants need water to survive and make food. It is one of the main elements which help them grow. Hence, water is extremely important for humans, animals, and plants to survive .

Get the huge list of more than 500 Essay Topics and Ideas

Do not Waste Water

While water is quite essential and yet so scarce, however, people fail to realize this fact. They waste water with little or no care for the results of this activity. There are various ways in which one can avoid wasting water . To begin with, all households must get their leaking taps checked. They should fix them immediately as every drop is precious.

Similarly, we must choose buckets instead of showers for bathing. This is a very debatable topic and it needs to be settled. Showers waste a lot of water, so people must prefer buckets. This particular habit is quite commonly found in most of the households. People do not turn off their taps while brushing their teeth and washing utensils. Always remember to keep the tap off when doing so.

In addition, encourage rainwater harvesting system in all homes. This can help conserve water like never before.

In short, water is essential for the survival of mankind. But, it is, unfortunately, being waster rapidly. Every citizen and government must come together to tackle this issue. Governments must ensure all areas get water equally. On the other hand, citizens must keep in mind to use it wisely and not waste it unnecessarily.

FAQs on Water

Q.1 State the importance of water.

A.1 Water is of the utmost importance for human and animal life. It gives us water to drink. It also comes in great use for farmers and industries. Even common man requires water for various purposes like drinking, cleaning, bathing and more.

Q.2 List the ways to avoid wastage of water.

A.2 Everyone must avoid wasting water. We can do so by fixing our leaking taps, avoiding showers for bathing, and turning off taps when brushing. Furthermore, we can adopt rainwater harvesting system to conserve water.

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Water, Sanitation and Hygiene, or WASH, are issues that affect the health and wellbeing of every person in the world. Everyone needs clean water to drink. Everyone needs a safe place to pee and poop. And everyone needs to be able to clean themselves. For many people, WASH concerns are taken for granted and their combined impact on life isn’t always appreciated.

But for hundreds of millions of others, water, sanitation and hygiene are constant sources of stress and illness. The quality of water, sanitation and hygiene in a person’s life is directly correlated to poverty, as it is usually joined by lack of education, lack of opportunity and gender inequality.  

What’s the scope of the problem?

780 million people do not have regular access to clean water.

2.4 billion people, or 35% of the global population, do not have access to adequate sanitation.

Inadequate sanitation generally means open defecation. When people defecate in the open without a proper waste management system, then the feces generally seeps into and contaminates water systems. Just standing in an open defecation zone can lead to disease, if, for instance, the person is barefoot and parasites are there.

The problem is concentrated in Sub-Saharan Africa, Southern Asia and Eastern Asia. The country with the most people lacking adequate WASH is India.

Girls are the hardest hit by lack of clean water and sanitation for a few reasons. When schools lack functional toilets or latrines, girls often drop out because of the stigma associated with periods. Also, when families don’t have enough water, girls are generally forced to travel hours to gather some, leaving little time for school. This lack of education then contributes to higher poverty rates for women.

What are the health risks?

There are a lot of health risks associated with inadequate WASH. Just imagine what it would be like if you were drinking contaminated water and everyone in your community defecated in the open.

801,000 kids under the age of 5 die each year because of diarrhea. 88% of these cases are traced to contaminated water and lack of sanitation.

More than a billion people are infected by parasites from contaminated water or open defecation. One of these parasites is called the Guinea Worm Disease, which consists of worms up to 1 meter in size that emerge from the body through blisters.

The bacterial infection Trachoma generally comes from contaminated water and is a leading cause of blindness in the world.

Other common WASH-related diseases include Cholera, Typhoid and Dysentery.

And, again, step back to consider what life without clean water and adequate sanitation would be like. A lot of your time would be spent trying to get clean water and avoid sanitation problems in the first place. And the hours not revolving around these concerns would probably be reduced quality of life because of the many minor health problems associated with poor water quality. Ultimately, inadequate WASH leads to reduced quality of life all the time.

What’s being done?

For every $1 USD invested in WASH programs, economies gain $5 to $46 USD. In the US, for instance, water infrastructure investments had a 23 to 1 return rate in the 20th century. When people aren’t always getting sick, they’re more productive and everyone benefits.

While the numbers are daunting, a lot is being done. And the economic benefits of WASH investments make the likelihood of future investments and future progress much higher.

Some investments are small-scale, others are large-scale. On the smaller side of the spectrum, investments can go toward water purification methods, community wells or sources of water and the construction of community latrines.

For instance, in a slum in Nairobi, Kenya, the government recently installed ATM-style water dispensers that provide clean water to the whole community.

Larger scale investments include piped household water connections and household toilets with adequate sewage systems or septic tanks.

An often overlooked aspect of WASH involves behavioral hygiene, and, more specifically, hand washing. Simply washing your hands with soap can reduce the risk of various diseases, including the number 1 killer of the world’s poorest children: pneumonia .

What progress has been made?

In 1990, 76% of the global population had access to safe drinking water and 54% had access to adequate sanitation facilities.

In 2015, even though the population had climbed by more than 2 billion people, 91% of people had access to safe drinking water and 68% had access to improved sanitation.

That means in 25 years, 2.6 billion people gained access to safe drinking water and 2.1 billion gained access to improved sanitation.

India is currently in the process of an unprecedented WASH investment program. At the 2014 Global Citizen Festival, Prime Minister Narendra Modi committed to end open defecation in the country and has since mobilized substantial resources with the help of The World Bank .

What role does Global Citizen play in all this?

Global Citizen puts pressure on world leaders to focus on and direct money to poverty solutions around the world. When it comes to WASH, global citizens have helped raise awareness of the various associated problems and motivate politicians to invest in specific programs.

Head over to our Impact page to read more about specific achievements. 

Defeat Poverty

Why Clean Water, Sanitation And Hygiene Are So Important

Aug. 23, 2016

UNICEF Data : Monitoring the situation of children and women

GOAL 6: CLEAN WATER AND SANITATION

Ensure availability and sustainable management of water and sanitation for all.

Goal 6 aims to ensure availability and sustainable management of water and sanitation for all. Water and sanitation are critical to the health of people and the planet. Goal 6 not only addresses the issues relating to drinking water, sanitation and hygiene (WASH), but also the quality and sustainability of water resources worldwide. Improvements in drinking water, sanitation and hygiene are essential for progress in other areas of development too, such as nutrition, education, health and gender equality.

Millions of people die every year from diseases associated with unsafe drinking water, sanitation and hygiene. Young children are particularly vulnerable – WASH-related diseases remain among the leading causes of death in children under 5, and they contribute to malnutrition and stunting. Each year, 300,000 children under 5 die due to diarrhoea linked to inadequate WASH. Despite significant progress, 2.2 billion people worldwide do not have safely managed drinking water services. Over half the global population, 4.2 billion people, lack safely managed sanitation services.

UNICEF’s contribution towards reaching this goal centres on bringing safe drinking water, sanitation and hygiene services to homes, schools and health centres so that children can grow and learn in a safe environment. UNICEF is co-custodian for global monitoring of three indicators that measure progress towards Goal 6: Indicator 6.1.1 Proportion of population using safely managed drinking water services; Indicator 6.2.1a Proportion of population using safely managed sanitation services; and Indicator 6.2.1b Proportion of population with a hand-washing facility with soap and water available at home.

Child-related SDG indicators

Target 6.1 by 2030, achieve universal and equitable access to safe and affordable drinking water for all, proportion of population using safely managed drinking water services.

• Indicator definition
• Computation method
• Comments & limitations

Explore the data

Safely managed drinking water means using an improved source that is accessible on premises, available when needed and free from faecal and priority chemical contamination. As such, the indicator combines information on both whether households have access to improved sources and the level of service they receive.

Proportion of the population using drinking water from an improved source that is accessible on premises, available when needed and free from contamination

Improved drinking water sources include the following: piped water into dwelling, yard or plot; public taps or standpipes; boreholes or tubewells; protected dug wells; protected springs; packaged water; delivered water and rainwater.

A water source is considered to be ‘accessible on premises’ if the point of collection is within the dwelling, yard, or plot.

‘Available when needed’: households are able to access sufficient quantities of water when needed.

‘Free from faecal and priority chemical contamination’: water complies with relevant national or local standards.

In the absence of such standards, reference is made to the WHO Guidelines for Drinking Water Quality ( http://www.who.int/water_sanitation_health/dwq/guidelines/en/ ).

E. coli or thermotolerant coliforms are the preferred indicator for microbiological quality, and arsenic and fluoride are the priority chemicals for global reporting.

Household surveys and censuses currently provide information on types of basic drinking water sources and also indicate if sources are on premises. These data sources often have information on the availability of water and increasingly on the quality of water at the household level, through direct testing of drinking water for faecal or chemical contamination. These data are combined with data on availability and compliance with drinking water quality standards (faecal and chemical) from administrative reporting or regulatory bodies. The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) estimates drinking water service levels by fitting a regression line to all available national data points in each country. The JMP 2017 update methodology describes in more detail how data on the type of water source used and the level of service received are combined to compute the safely managed drinking water services indicator. ( https://washdata.org/report/jmp-methodology-2017-update )

Data on availability and safety of drinking water are increasingly available through a combination of household surveys and administrative sources including regulators, but definitions have yet to be standardized. Data on faecal and chemical contamination, drawn from household surveys and regulatory databases, will not cover all countries immediately. However, sufficient data were available to make estimates of safely managed drinking water services for 117 countries and four out of eight SDG regions in 2019.

Click on the button below to explore the data behind this indicator.

TARGET 6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

Proportion of population using safely managed sanitation services.

Safely managed drinking water means using an improved sanitation facility that is not shared with other households and where excreta are either safely disposed of in situ or removed and treated off-site. As such, the indicator combines information on both whether households have access to improved toilets and safe treatment and disposal of the wastes produced.

Proportion of population using an improved sanitation facility that is not shared with other households, from which excreta are safely disposed of in situ or removed and treated off-site

Improved sanitation facilities include the following: flush or pour flush toilets to sewer systems, septic tanks or pit latrines, ventilated improved pit latrines, pit latrines with a slab, and composting toilets.

Safely disposed of in situ: if pit latrines and septic tanks are not emptied and excreta are contained and treated in situ they are considered safely managed. Excreta emptied from septic tanks and pit latrines and buried in a covered pit are also counted as safely disposed of in situ.

Treated offsite: excreta may also be emptied from septic tanks and pit latrines and delivered to a faecal sludge treatment plant, or conveyed in sewers to a wastewater treatment plant. For SDG monitoring, excreta receiving secondary or higher levels of treatment are considered safely managed.

For detailed guidance on safe sanitation see the WHO Guidelines on Sanitation and Health ( https://www.who.int/water_sanitation_health/sanitation-waste/sanitation/sanitation-guidelines/en/ )

Method of computation: Household surveys and censuses provide data on use of types of basic sanitation facilities. The percentage of the population using safely managed sanitation services is calculated by combining data on the proportion of the population using different types of basic sanitation facilities with estimates of the proportion of faecal waste which is safely disposed in situ or treated off-site. The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) estimates sanitation service levels by fitting a regression line to all available national data points in each country. The JMP 2017 update methodology describes in more detail how data on the type of sanitation facility used and the disposal and treatment of exreta are combined to compute the safely managed sanitation services indicator. ( https://washdata.org/report/jmp-methodology-2017-update ).

Data on emtpying and disposal of waste from on-site facilities and the treatment of wastewater from sewer connections are increasingly available through a combination of household surveys and administrative sources including regulators, but definitions have yet to be fully standardized. Data on containment, disposal and treatment of faecal sludge and wastewater will not cover all countries immediately. However, sufficient data were available to make estimates of safely managed sanitation services for 96 countries and for six out of eight SDG regions in 2019.

Proportion of population with a handwashing facility with soap and water available at home

A basic handwashing facility means having a fixed or mobile handwashing facility with soap and water available on premises.

Proportion of population with a handwashing facility with soap and water available on premises

A handwashing facility is a device to contain, transport or regulate the flow of water to facilitate handwashing.

Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing.

Soap includes bar soap, liquid soap, powder detergent, and soapy water but does not include ash, soil, sand or other handwashing agents.

Observing the presence of handwashing facilities with soap and water is is a proxy indicator of actual handwashing practice, which has been found to be more accurate than other proxies such as self-reports of handwashing practices

Household surveys and censuses provide data on the presence of handwashing facilities and soap and water in the home. The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) estimates access to handwashing facilities by fitting a regression line to all available national data points in each country. The JMP 2017 update methodology describes in more detail how data are combined to compute the basic handwashing facility indicator. ( https://washdata.org/report/jmp-methodology-2017-update )

The presence of a handwashing station with soap and water does not guarantee that household members consistently wash hands at key times, but has been accepted as the most suitable proxy. However sufficient data were available to make estimates for 78 countries and for three out of eight SDG regions in 2019.

To achieve SDG 6, governments must invest in their communities and bridge the economic and geographic divides to deliver the human rights to safe water, sanitation and hygiene. UNICEF has four key asks that encourage governments to:

• Reaffirm their commitment to improve access to basic water, sanitation and hygiene services.
• Strengthen partnerships with the national statistics offices towards the collection, analysis and use of disaggregated data and routinely measure progress towards equitable access to safe water, sanitation and hygiene.
• Report progress on national action.
• Ensure the continuity and quality of WASH services during the COVID-19 crisis and sustain affordable access to WASH products and services for the poorest and most vulnerable populations.

Learn more about  UNICEF’s key asks for implementing Goal 6

See more Sustainable Development Goals

ZERO HUNGER

GOOD HEALTH AND WELL-BEING

QUALITY EDUCATION

GENDER EQUALITY

CLEAN WATER AND SANITATION

AFFORDABLE AND CLEAN ENERGY

DECENT WORK AND ECONOMIC GROWTH

REDUCED INEQUALITIES

CLIMATE ACTION

PEACE, JUSTICE AND STRONG INSTITUTIONS

PARTNERSHIPS FOR THE GOALS

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Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact

Many schools in low-income countries have inadequate access to water facilities, sanitation and hygiene promotion. A systematic review of literature was carried out that aimed to identify and analyse the impact of water, sanitation and hygiene interventions (WASH) in schools in low-income countries. Published peer reviewed literature was systematically screened during March to June 2018 using the databases PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and Google Scholar. There were no publication date restrictions. Thirty-eight peer reviewed papers were identified that met the inclusion criteria. The papers were analysed in groups, based on four categories of reported outcomes: (i) reduction of diarrhoeal disease and other hygiene-related diseases in school students; (ii) improved WASH knowledge, attitudes and hygiene behaviours among students; (iii) reduced disease burden and improved hygiene behaviours in students’ households and communities; (iv) improved student enrolment and attendance. The typically unmeasured and unreported ‘output’ and/or ‘exposure’ of program fidelity and adherence was also examined. Several studies provide evidence of positive disease-related outcomes among students, yet other assessments did not find statistically significant differences in health or indicated that outcomes are dependent on the nature and context of interventions. Thirteen studies provide evidence of changes in WASH knowledge, attitudes and behaviours, such as hand-washing with soap. Further research is required to understand whether and how school-based WASH interventions might improve hygiene habits and health among wider family and community members. Evidence of the impact of school-based WASH programs in reducing student absence from school was mixed. Ensuring access to safe and sufficient water and sanitation and hygiene promotion in schools has great potential to improve health and education and to contribute to inclusion and equity, yet delivering school-based WASH intervention does not guarantee good outcomes. While further rigorous research will be of value, political will and effective interventions with high program fidelity are also key.

1. Introduction

Schools with adequate water, sanitation and hygiene (WASH) facilities have: a reliable water system that provides safe and sufficient water, especially for hand-washing and drinking; sufficient number of toilets for students and teachers that are private, safe, clean, and culturally and gender appropriate; water-use and hand-washing facilities, including some close to toilets; and sustained hygiene promotion [ 1 ]. Facilities should cater to all, including small children, girls of menstruation age, and children with disabilities. WASH conditions in schools in many low-income countries, however, are inadequate with associated detrimental effects on health and school attendance [ 2 ]. An evaluation by UNICEF [ 3 ] found that in schools in low-income countries, only 51% of schools had access to adequate water sources and only 45% had adequate sanitation.

Globally, school-based WASH interventions variously aim to: (i) reduce the incidence of diarrhoea and other hygiene related diseases; (ii) improve school enrolment, school performance, and attendance; and (iii) influence hygiene practices of parents and siblings whereby children act as agents of change in their households and communities. However, evidence assessing the impact of school-based WASH interventions has been mixed. Two previous reviews of studies of the impact of school-based WASH interventions have shown mixed results on outcome measures such as knowledge, attitudes and practices, school attendance, and health [ 2 , 4 ]. The review by Jasper et al. [ 2 ] had a global focus and most included studies ( n = 41) were from high- and middle-income countries (e.g., United States, United Kingdom); Joshi and Amadi [ 4 ] also had a global focus including studies from North America and Europe and their review was confined to studies ( n = 15) published between 2009–2012.

The objective of this review is to analyse published peer-reviewed journal articles that focus on WASH in schools in low-income countries. The review focuses on intervention-based studies and key outcome measures including: health among school students (e.g., diarrhoeal disease and other hygiene-related diseases); WASH knowledge, attitudes and hygiene behaviours among students; changes in disease burden and hygiene behaviours in students’ households and communities; changes in student enrolment and school attendance. The review also considers the under-reported indicator of intervention fidelity. The review highlights gaps in knowledge and potential future research directions.

2. Materials and Methods

Published peer reviewed journal articles were included that examined the impacts of school-based WASH intervention in low-income countries. WASH interventions included: hand-washing initiatives (e.g., water, wash basins, soap, drying devices); drinking water initiatives; improved sanitation (improved toilets, facilities for menstruation); and hygiene behaviour initiatives (e.g., handwashing with soap, hygiene education). Reported outcomes include: educational outcomes (i.e., school attendance, school dropout); hygiene behaviours, knowledge and attitudes; and health (i.e., WASH-related illness). Intervention fidelity—adherence to intervention delivery standards—was also reported in several studies (either as an ‘exposure’ or ‘outcome’). Article inclusion was restricted to those with a focus on low-income countries, defined as countries with a Gross National Income (GNI) per capita (calculated using the World Bank Atlas method) of 1005 USD or less in 2016. The review was restricted to articles for which the abstract and article was available in English language.

Descriptive studies of school-based WASH conditions, without evaluative focus on intervention impacts, were excluded [ 5 , 6 ]. Morgan et al. [ 5 ], for example conducted a cross-sectional survey of 2270 WASH intervention beneficiary schools in Ethiopia, Kenya, Mozambique, Rwanda, Uganda and Zambia and found that fewer than 23% of rural schools met World Health Organization recommended student-to-latrine ratios. While descriptive studies provide important insight into the context and challenges for WASH in schools, they are not the focus here.

The following electronic databases were searched during March to June 2018: PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and Google Scholar. The search was based on the keywords: WASH or water or sanitation or soap or hygiene or “hand hygiene” or “hand wash*” AND school or attendance AND “low income” or “developing country” or “developing nations”. For example, in Embase the following search terms were deployed: (WASH OR water OR hygiene OR “hand hygiene” OR “hand wash*” OR sanitation OR Soap* OR “child* health”) AND (school OR attendance) AND (“low income country” OR “developing country”). References of included articles were systematically searched for relevant documents. There were no publication date restrictions.

3.1. Systematic Review and Yielded Studies

The initial search terms identified 1498 publications; 11 additional articles were identified from other sources. The secondary screening—based on the title—identified 119 articles with a potential focus on WASH in schools in low-income countries. Thirty eight of these articles met the inclusion criteria, following screening by abstract and then full text. Bibliographies of these references identified no additional articles (see Figure 1 ).

Flow chart showing procedure for article selection.

For each article, a summary of key information was tabled: i.e., country of study, study design, study population (number of schools, children, and/or their age), exposure/intervention, outcome measure, key findings. As the studies use diverse methods and outcome measures no attempt was made to weight the value of findings according to study quality, or to conduct meta-analysis of study findings. Of the 38 articles: 47% reported the intervention impact on diarrhoeal disease and other hygiene-related diseases in school students; 34% reported changes in WASH knowledge, attitudes and hygiene behaviours among students; 16% reported impact on disease burden and hygiene behaviours in students’ households and communities; 32% reported changes in student enrolment and school attendance; and 11% reported on intervention fidelity (see Table 1 ). Twelve studies reported outcome measures across more than one category [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ] (see Table 1 ).

Outcome measures reported in included articles ( n = 38).

Countries of focus included Bangladesh, Burkina Faso, Cambodia, China, Colombia, Egypt, Ethiopia, Ghana, India, Indonesia, Kenya, Lao People’s Democratic Republic, Mali, Niger, Nepal and Tanzania. Study methods included cross-sectional survey, non-randomized trial, cluster-randomized trial, and before and after intervention studies. Study design is identified in Table 2 .

Published evaluations of WASH in schools in low-income countries.

3.2. Reduced Diarrhoea and other WASH-Related Diseases in School Students

Despite the biological plausibility that improvements in school WASH conditions will be beneficial for pupil health, results from school-based WASH evaluations have been mixed. There is evidence that WASH in Schools programs have a positive impact on child health, including reductions in diarrhoeal disease and other hygiene-related diseases. Migele et al. [ 28 ] examined the impact of a simple school-based water treatment and hand-washing intervention in a boarding school in Kenya: i.e., clay pots modified with narrow mouths and ceramic lids, taps for drinking water, plastic tanks with taps for hand washing, WaterGuard (i.e., sodium hypochlorite solution) for drinking water, and soap for hand washing. Before-and-after rates of diarrhoea disease (with no control schools) indicated a more than 50% reduction in recorded cases of diarrhoea among students. In their evaluation of WinS interventions in Mali, Trinies et al. [ 18 ] found that, as compared with control schools, there were lower odds of students in beneficiary schools reporting diarrhea (OR 0.71, 95% CI 0.60–0.85) or respiratory infection symptoms (OR 0.75, 95% CI 0.65–0.86) in the past week. And a study in rural Kenya [ 15 ] found that school-based water treatment and hygiene programs resulted in a decrease in rates of acute respiratory illness, although no decrease in acute diarrhea was observed. Improving school-based WASH can also reduce other hygiene-related diseases, such as soil-transmitted helminth (STH) infection [ 7 , 21 , 22 ]. For example, Bieri et al. [ 7 ] found that among Chinese school-children, the incidence of infection with STHs was 50% lower in the intervention group that received a STH education package than in the control group (4.1% vs. 8.4%, p < 0.001). And in Mali, Freeman et al. [ 22 ] found that provision of school-based sanitation, water quality, and hygiene improvements reduced reinfection of some STHs after school-based deworming, but the magnitude of the effects were helminth species-specific.

Results, however, are not uniformly clear or positive. In an evaluation of a hand-washing promotion program in Chinese primary schools, rates of diarrhoea were too low in both intervention and control groups to identify attributable differences in prevalence [ 35 ]. Some studies indicated that basic interventions that include hygiene promotion, water treatment, and behaviour change did not reduce rates of diarrhoeal disease [ 11 , 15 ]. In a multi-country study, Dujister et al. [ 20 ] found that the STH prevalence at baseline and at follow-up did not significantly differ between intervention schools (that provided deworming and improved handwashing) and control schools. And a study by Greene et al. [ 25 ] conducted in schools in western Kenya found that hygiene promotion and water treatment did not reduce risk of Escherichia coli presence on pupils’ hands; further, the addition of new latrines to intervention schools significantly increased E. coli presence among girls (RR = 2.63, 95% CI 1.29–5.34) which they attributed to an absence of sufficient hygiene behaviour change, and lack of soap, water, and anal cleansing materials. It is important to note, however, that presence of E. coli on hands is a variable that is difficult to interpret in terms of disease risk and outcomes.

Context is important. For example, Freeman et al. [ 11 ] found that local water availability affected the impact of school-based WASH interventions on diarrhoea rates among pupils. Pupils attending ‘water-scarce’ schools (in which there was no dry-season water source within 1km) that received WASH intervention (including water-supply improvement, hygiene promotion and water treatment, and sanitation improvements) reported a reduction in diarrhoea incidence and days of illness; they reported a 56% difference in the risk of diarrhoea for pupils attending intervention vs. control schools in water-scarce sites (adjusted risk ratio (aRR) 0.34, 95% CI 0.17–0.64). No statistically significant effect was detected for any intervention in ‘water-available schools’, nor for ‘water-scarce’ schools that received only hygiene promotion and water treatment. Similarly, Garn et al. [ 44 ] found that in water-scarce schools in Kenya, there was reduced prevalence of diarrhea among pupils attending schools that adhered to two or three intervention components (prevalence ratio 0.28, 95% CI 0.10–0.75), compared with schools that adhered to zero components or one. It was not clear why results were different in water-scarce versus water-available schools, but it is possible that WASH interventions in water-scarce schools were more comprehensive.

There is widespread recognition that WASH infrastructure and resources are important foundations for hygiene behaviour change and reduced risk of WASH-related diseases. There is evidence, however, that latrine construction, without other supporting water and hygiene-related interventions, is not effective at reducing diarrhoeal disease [11, 20). Possible explanations are that without broader hygiene promotion and latrine maintenance efforts, construction of latrines alone may not result in their use or (conversely) latrines may increase exposure to faecal pathogens if they are poorly maintained, used incorrectly, or if hygiene resources are not available during and after use [ 11 , 36 ]. The health benefits of improved WASH infrastructure and resources in schools may depend on consistent availability of soap and water for handwashing and on conditions of the latrines, not only pupil to latrine ratios [ 26 ].

3.3. Improved WASH Knowledge, Attitudes and Hygiene Behaviours

Thirteen studies measured WASH knowledge, attitudes and hygiene behaviours among students (see Table 1 ); all found evidence of improved knowledge, attitudes and behaviours associated with WinS program. Dreibelbis et al. [ 29 ] report findings of an intervention that aimed to improve hand-washing after toilet use among students in two primary schools in rural Bangladesh. Dedicated locations for hand-washing were constructed in both schools. Two nudges were implemented: first, connecting latrines to hand-washing stations via brightly painted paved pathways; second, painting footprints on pathways guiding students to the handwashing stations and handprints on stations. Soap was provided and schools were asked to make soap available and refill water storage containers each day. At baseline, hand-washing with soap (HWWS) was low (4%); this increased to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. The high rates of observed handwashing post-intervention suggest that nudges can have sustained effects on hygiene behaviours. A related cluster-randomized trial in schools Bangladesh [ 30 ] demonstrated comparable increases in rates of handwashing with soap five months after intervention both for a nudge intervention (paved path with painted shoe-prints and arrows connecting latrines to the handwashing facility, painted handwashing station with handprints and a dedicated location for soap) and high intensity hygiene education initiatives. La Con et al. [ 31 ] found that installation of water and handwashing stations in schools in rural Kenya, coupled with WASH education, enabled student handwashing with stations located closer to latrines (<10 m) used much more frequently. One randomized cluster trial in rural Kenya [ 17 ] examined the impact of provision of regular soap and latrine cleaning materials and hygiene education; pupil hand-washing rates following toileting were observed to be 32–38% in intervention schools compared to 2% of students in control schools. Another randomized cluster trial in urban Nairobi, Kenya, examined the impact of teacher hygiene training and provision of regular alcohol-based hand sanitizer or liquid soap; pupil hand-washing rates following toileting were observed to be 82% at schools with sanitizer, 38% at schools with soap, and 37% at control schools [ 16 ].

3.4. Reduced Disease Burden and Improved Hygiene Practices in Households and Communities

In addition to limiting pathogen transmission in the public domain—such as at schools—school-level WASH interventions may also reduce community disease burden and improve hygiene knowledge. One study in Kenya found that in water-scarce areas, school-based WASH interventions that included improvement in water supply reduced diarrhoea among school students’ siblings under the age of five who were not attending school [ 33 ]. The authors suggest this could be due to diffusion of improved hygiene practices and behaviours in both home environments and community, or interruption of pathogen transmission in school contexts thereby reducing exposure and transmission in domestic environments. Another study in Kenya documented transfer of knowledge from school students to their parents, identifying increased parental awareness and household use of water treatment with flocculent disinfectant following student hygiene education and provision of water treatment products to students; improved household water treatment practices were sustained over one year [ 32 ]. A study of a school-based WASH intervention in Kenya documented the transfer of knowledge about point-of-use water treatment practices and increased utilisation of WaterGuard in student’s households as indicated by having chlorine residuals in stored water; parents also reported improved hand-washing and 38% of parents demonstrated correct hand-washing technique [ 14 ]. However, based on their study in Burkina Faso, Erismann et al. [ 10 ] warn that although children can promote health messages to family members, effective behaviour changes among family members is more difficult to achieve due to the challenge of changing practices and the broader constraints that limit improved behaviours (e.g., water scarcity).

3.5. Improved Student Enrolment and Attendance

In this review, twelve studies in low-income countries were identified that examined the impact of school-based WASH programs on student absence and enrolment. Improved school WASH conditions may reduce student absence by providing services (including, importantly, for girls who are menstruating) and by reducing illness transmission [ 45 ]. There is some evidence that improved hand-washing with soap at school can reduce illness in school-aged children thereby reducing absence from school [ 11 , 14 , 15 , 18 , 21 , 35 , 41 ].

Interventions that deliver hand-washing promotion and point-of-use water treatment have reported reductions in student absence of between 21% [ 32 ] and 61% [ 38 ] with one study specifically identifying reduced absence among girls (i.e., 58% reduction in the odds of absence for girls) [ 21 ]. A school-based water and hygiene intervention in public primary schools in Kenya found a decrease in student absence of 35% relative to baseline as compared to a 5% increase in neighbouring schools [ 14 ]. Talaat et al. [ 41 ] identified a 21% reduction in school absence from all illnesses (e.g., diarrhea, conjunctivitis, influenza) as a result of an intensive hand-washing campaign in Egypt; absences caused by influenza-like illness, diarrhea, conjunctivitis, and laboratory-confirmed influenza were reduced by 40%, 33%, 67%, and 50%, respectively. A small pilot study in Ghana entailed provision of sanitary pads and puberty education to adolescent girls in both intervention and control schools, with the intervention found to significantly improve attendance [ 39 ]. Evaluation of a comprehensive WASH intervention in schools in Bangladesh—using a non-experimental survey design—reported a 9–12% reduction in school absence among girls (varying between schools) [ 42 ]. A trial of school-based WASH interventions in Kenya found that cleanliness of latrines was strongly correlated with recent student absence [ 37 ]. And a study of hand-washing intervention in Chinese primary schools found that the expanded intervention (standard government education plus hand-washing program, soap for sinks, and peer hygiene monitors) reported 42% fewer absence episodes and 54% fewer days of absence, and the standard intervention (handwashing program) reported 44% fewer absence episodes and 27% fewer days of absence [ 35 ].

Some intervention studies, however, found no evidence of impact on attendance. A study in the Chitwan region of Nepal [ 40 ] trialled the use of menstrual cups (a silicone cup used internally for menstrual flow management) with a small sample of schoolgirls. The study found the technology had no impact on school attendance or school test outcomes; the authors suggest this is because the technology assisted only with management of blood, and did not reduce cramps which were reported as the primary reason for non-attendance. However, the study had several limitations including self-reporting of menstrual cup usage, and lack of consideration of existing water and sanitation facilities in schools. And a trial in Kenya to assess the impact of a scalable, low-cost, school-level latrine cleaning intervention on pupil absence did not find a reduction in absenteeism; the authors hypothesised that the additional impact of cleaning may not have been sufficient to reduce absence beyond reductions attributable to the original WASH intervention [ 36 ].

3.6. Intervention Fidelity

Effectiveness of interventions is associated with the typically unmeasured and unreported ‘output’ and/or ‘exposure’ of intervention delivery including program fidelity and adherence. Three studies reported on intervention fidelity but did not draw conclusions as to its effect on measured outcomes. Chard and Freeman [ 9 ] report on a WASH intervention in Laotian primary schools and found inadequate school-level adherence to project outputs (e.g., soap provision, water availability, hygiene promotion activities); the differential impact of school-level intervention fidelity on measured hygiene behaviours (e.g., toilet use and daily hygiene activities) was not reported. Alexander et al. [ 43 ] assessed whether student and parental monitoring and additional funding for repairs and maintenance affected the fidelity and effectiveness of school-based WASH service provision in 70 schools in Western Kenya; no clear results emerged. Hetherington et al. [ 12 ] reported on an initiative in Tanzania that aimed to engage high-school students and the wider community in improving sanitation and hygiene. While they noted challenges of intervention adherence and fidelity—including timing of activities, communication between schools and local coordination, and inadequate supplies and allowances to support activities—the impact of these challenges on the primary outcome measures (i.e., hygiene knowledge, attitudes, behaviours) was not assessed. Garn et al. [ 44 ] provide rare evidence of the impact of intervention adherence and found that among water-scarce schools in Kenya improved adherence resulted in reduced prevalence of diarrhoea among pupils.

4. Discussion

Access to WASH facilities and hygiene behaviour change education in schools contribute to inclusion, dignity, and equity. From a human rights perspective, WASH in schools is considered essential. The Sustainable Development Goals (SDGs) implicitly highlight the need to expand WASH beyond household settings, in the effort to achieve universal and equitable access to safe and affordable drinking water, sanitation and hygiene for all. The SDGs explicitly refer to WASH in Schools in Target 4.a via the indicator of the “proportion of schools with access to: (e) basic drinking water; (f) single-sex basic sanitation; and (g) basic handwashing facilities” [ 46 ]. However, the aim is to not only provide adequate ratios, but to ensure positive outcomes across diverse measures including diarrhoeal disease and other WASH-related diseases, hygiene behaviour and school attendance.

There is biological plausibility supporting the health and educational benefits of providing WASH in schools, as well as rights-based arguments for WASH in Schools. The studies in this review indicate that school-based WASH interventions can protect against diarrhoea and other WASH-related illness such as soil-transmitted helminths and acute respiratory infections, increase WASH-related knowledge and practices, and improve educational outcomes including reduced absence.

Fourteen (78%) of the 18 publications that reported disease-related outcomes found reductions in diarrhoeal disease and other hygiene-related diseases, such as respiratory illness and soil-transmitted helminths, among students at intervention schools (c.f. [ 7 , 18 , 21 , 28 ]). Of these publications reporting positive health outcomes, however, more than half also reported that there were no statistically significant reductions for some disease-related outcomes: e.g., intestinal parasitic infections prevalence, but not undernutrition, was found to decrease [ 10 ]. Four of the 18 publications reported no evidence of reduced risk for the primary disease-related outcome measures, including soil-transmitted helminths and E. coli on pupils’ hands [ 17 , 20 , 25 , 26 ].

All of the 13 publications that examined changes in WASH knowledge, attitudes and hygiene behaviours reported evidence of positive change among students in intervention schools including hand-washing with soap or sanitizer [ 8 , 16 , 29 , 30 , 31 ], improved knowledge of WASH-related diseases, and improved hygiene habits [ 7 , 13 ].

Six studied examined whether WASH interventions in schools led to reductions in the family and community burden of WASH-related diseases and improved WASH knowledge at the family and community level. They provide very limited evidence of improvements in WASH-related knowledge and behavior and reduced WASH-related disease among family [ 14 , 32 , 33 ]. Further research is required to understand whether and how school-based WASH interventions can improve hygiene habits and disease-related outcomes among wider family and community members [ 29 ].

Demographic factors are key predictors of student absence from school, including gender and socio-economic status [ 37 ]. Nonetheless, WASH-related illnesses have been estimated to result in hundreds of millions of days of school absence [ 47 ]. Twelve publications examined the impact of school-based WASH interventions on student absence in low-income countries and the findings were mixed. There is some evidence that improved hand-washing with soap at school, provision of sanitary pads, maintained and clean latrines can reduce absence in school-aged children (c.f. [ 11 , 18 , 35 , 37 , 42 ]), but a few studies found that school-based WASH interventions had no impact on student attendance [ 36 , 40 ].

Importantly, intervention effectiveness is affected by intervention delivery, including program fidelity and adherence. Freeman et al. [ 11 ] warn that suboptimal intervention fidelity often means that researchers evaluate the effectiveness of interventions in real-world settings, not ideal ‘best practice’ for WASH environments. Yet, while various publications mention the challenges of fidelity and adherence in school-based WASH interventions, their impact on outcomes is rarely assessed; only one study in schools in Kenya specifically demonstrated that improved intervention adherence resulted in reduced prevalence of diarrhoea among pupils [ 44 ]. Studies such as these highlight that ensuring consistent and effective delivery of WASH interventions in low-resources contexts, including school-based interventions, remains a challenge.

So, there is no universal blueprint and effects are not consistent between studies as both context and intervention type matter. For example, the effectiveness of an intervention in reducing diarrhoeal disease may be based on background rates of disease, pathogen-pathways in specific environments, student populations, baseline WASH conditions such as water availability, and broader social, political and economic contexts [ 11 , 44 ]. Several publications emphasise that combined interventions that include multiple components—for example, latrine construction, hygiene promotion, latrine maintenance, and sustained provision of resources such as soap and water for handwashing—are more effective at reducing WASH-related diseases than single interventions such as construction of latrines [ 11 , 21 , 36 ].

Evaluative research of WASH in Schools encounters challenges which influence results and their interpretations, including: restrictions in randomisation, the potential of crossover effects, and circumstances beyond the researchers’ control such as the interference of other health programmes. The definition of illness outcomes such as “diarrhea” are not uniform across studies which makes inter-study comparison difficult. And, importantly, evaluations of WASH interventions in low-resource settings often measure outcomes—such as diarrheal disease—via self-report, an approach prone to recall and social desirability biases, subjective interpretations of the definition of “diarrhea”, and imprecise measurements of incidence [ 9 ]. It is notable that of the 18 studies in this review that report disease-related outcomes, ten (56%) included objective rather than self-reported measures of disease and infection: for example, fecal samples were examined for soil-transmitted helminths, intestinal protozoa and other parasites [ 7 , 8 , 10 , 11 , 20 , 22 , 24 , 26 ], blood samples were collected to measure blood hemoglobin concentration [ 26 ], and hand-rinse samples were analysed for E. coli [ 17 , 25 ].

The theory of change embedded in project design also influences the nature of an intervention and its delivery. In their evaluation of Project SHINE (Sanitation and Hygiene INnovation in Education) in Tanzania, for example, Hetherington et al. [ 12 ] highlighted the value of strategies that enable communities to develop locally sustainable approaches to improving their health, in contrast to other models (e.g., Community Led Total Sanitation) which incorporate shaming and disgust techniques to promote behaviour change. Theories of change must be considered to fully understand effectiveness, or lack thereof, rather than reducing interventions to processual elements of exposure and outcome.

Notably, several studies have examined the onset and management of menses in low-income countries, with a specific focus on the challenges of menstrual hygiene management (MHM) in school environments (e.g., negative attitudes, limited health and sexuality information, inadequate facilities and privacy) (c.f. [ 48 , 49 , 50 ]). However, these studies are qualitative and/or descriptive; very few intervention studies include a focus on menstrual hygiene management in schools in low-income countries [ 39 , 40 , 43 ].

This review contributes to understanding of the impact of school-based WASH interventions beyond the two existing reviews of school-based WASH by Jasper et al. [ 2 ] and Joshi and Amadi [ 4 ]. First, these two existing reviews have no restrictions on study location and more than two thirds of the 41 articles in the review by Jasper et al. [ 2 ] report findings of research conducted in high-income countries (e.g., United Kingdom, United States, Germany) and almost one third of the 15 articles in the review by Joshi and Amadi [ 4 ] were conducted in developed countries; this review has an explicit focus on low-income countries where there is the greatest need for improved access to safe drinking water, improved sanitation, handwashing facilities and hygiene education [ 47 ]. Second, these reviews necessarily include only publications available up to 2012: the Jasper et al. review [ 2 ] had no time restriction on the date of publication and the search was conducted in 2010 and updated in 2012; the Joshi and Amadi [ 4 ] review was restricted to studies published between 2009 and 2012 and the search was conducted in 2013. In this review, however, twenty-five of the 38 studies included were published after 2012. The contribution of this review, then, is its explicit focus on low-income countries and its inclusion of the substantial body of relevant research published in the last several years.

5. Conclusions

It is important to better understand disease-related and educational outcomes of school-based WASH interventions. This can help governments and donors allocate resources to school-based WASH interventions and enable agencies to design and implement effective interventions [ 11 ]. Intervention studies of WASH in schools in low-income settings are both expensive and challenging. There is, arguably, no need for additional large-scale epidemiological studies on the impact of WinS on diarrhoea among students as numerous studies have found evidence of positive outcomes related to diarrhoeal disease [ 11 ]. There is, however, still a need to better understand the differential impacts of different types of WinS programmes for broader health and educational outcomes, the extent to which students operate as change agents in wider communities, the role of independent variables including gender and socio-economic status, and the effect of targeted initiatives on menstrual hygiene management and girls’ school attendance. Further, there is value in conducting process evaluations that identify opportunities and challenges within program implementation, including theories of change and intervention fidelity. Political will and financing and effective delivery of interventions will be required to ensure universal access to WASH in Schools including in low-income countries.

Acknowledgments

The author would like to thank the librarian who assisted with the search strategy associated with this publication, David Honeybone at The University of Melbourne.

This research received no external funding.

Conflicts of Interest

The author declares no conflict of interest.

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Drinking water essay.

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Of all the uses of water, drinking water is the most fundamental, since the lack of safe and sustained water to drink is life-threatening. Yet, according to the United Nations (UN), as of 2002, nearly 20 percent of the world’s population still lacked regular access to clean drinking water. Of these 1.1 billion people, 65 percent were in Asia, 27 percent in Africa, 2 percent in Europe and 6 percent in Latin America and the Caribbean.

In most countries, the state is responsible for the provision of drinking water. Any drinking water supply system consists of three major elements: source (surface water sources such as lakes, rivers, and reservoirs, as well as groundwater sources such as wells), treatment (e.g., adding disinfectants such as chlorine), and distribution to users (including pricing). Drinking water supply systems have had a long history; for instance, the ancient Greeks and Romans were among the first to introduce long-distance water pipelines. However, in recent times, the question of provision of drinking water has become even more critical and complex, particularly with the growth of large cities that are situated at a considerable distance from adequate and reliable sources of water.

How much water people need for drinking varies according to diet, climate and the work they do. The minimum amount of water needed for drinking ranges from about 2 liters in temperate climates to about 5 liters per day for people in hot climates who have to carry out manual work. Pregnant and breastfeeding women need more water. Water for basic needs goes beyond water needed for survival; it includes water for cooking and to maintain a standard of personal and domestic hygiene that is sufficient to maintain health.

Apart from the quantity requirement, drinking water also needs to meet certain minimal quality requirements. Drinking water can be contaminated by a range of chemicals (lead, arsenic, benzene), microbes (bacteria, viruses, parasites), and physical hazards (glass chips, metal fragments) that can pose risks to health if present at high levels. Consuming such contaminated water can lead to waterborne diseases like diarrhea, cholera, typhoid and dysentery, and is one of the leading causes of illness and death in the developing world. The World Health Organization has put in place norms on water quality, which form the basis for regulation and standard-setting in many national, regional and local laws. However, standards for drinking water quality continue to be either ill-defined or poorly implemented in many countries.

The question of quality of water is also closely related to the question of sanitation. This is because one of the primary causes of contamination of water is the inadequate or improper disposal of human (and animal) excreta. Meeting adequate levels of sanitation is critical in order to ensure that drinking (and other) water meets certain quality standards.

Access to Water

Apart from quantity and quality requirements, in order for drinking water to be secure and useable, everyone must also have safe and easy access to water facilities. For instance, in households using only a remote and unprotected source, health can be jeopardized by water contamination. Further, collecting water from distant sources could also mean that a lot of time is spent on the task, with the result that women and children (who are the ones who bear the burden of collecting water in many cultures) are unable to undertake other productive activities (like going to school).

In addition, there is also the risk of injury while carrying heavy loads. Global coverage figures from 2002 indicate that out of every ten people, roughly five have a connection to a piped water supply at home (in their dwelling, plot, or yard); three make use of some other sort of improved water supply, such as a protected well or public standpipe; and two are unserved, with no choice but to rely on potentially unsafe water from rivers, ponds, unprotected wells, or water vendors.

Drinking water also needs to be affordable. The World Health Organization recommends that no more than 3 to 5 percent of an individual’s income should be spent on water. However, the poor often pay far higher amounts for water that is neither safe in terms of quality nor reliable in terms of timing.

Four Dimensions of Drinking Water

The four dimensions of drinking water-quantity, quality, accessibility, and affordability-are currently facing high degrees of pressure.

The supply of water in the world has always been finite. Only 3 percent of the world’s water is fresh water, most of which is locked in the icecaps of Antarctica and Greenland or in deep underground aquifers, which remain technologically or economically beyond our reach; further, only 0.3 percent of the world’s total freshwater reserves is found in the reserves and lakes that constitute the bulk of our usable supply. However, the current shortages in safe and drinking water are also a result of wasteful and unsustainable consumption of water, along with competing (and often more powerful) demands of industry and agriculture. Newer options, such as reusing wastewater, are beginning to be considered.

Similarly, the question of quality has acquired great importance in recent years in the light of growing groundwater pollution as well as contamination of surface water bodies. For instance, in the late 1990s, groundwater in Bangladesh in south Asia was discovered to be contaminated with high levels of arsenic. The deterioration in quality in many places is in large measure due to chemical fertilizers and pesticides used in agriculture as well as dumping of household and industrial waste without treatment. The question of affordability of drinking water has also come to the forefront in recent times (in parts of Africa and Latin America, for instance) due to attempts in many parts of the world to meet costs of public drinking water systems by raising tariffs, and/or privatizing existing water supply systems.

In spite of the high importance of water, it is important to note that a human right to safe and adequate drinking water has still not been fully defined by existing international law or practice, although it is supported by many human rights instruments as well as other international laws, declarations and state practice. To date, the most explicit formulation on the right to water at the international level is the General Comment 15 adopted by the UN Covenant on Economic, Social and Cultural Rights in November 2002. The 145 countries that have ratified the covenant are bound to ensure that everyone has access to safe and secure drinking water, equitably and without discrimination.

Bibliography:

• Peter Gleick, Water in Crisis: A Guide to the World’s Fresh Water Resources (Oxford University Press, 1993);
• UNESCO-WWAP, The United Nations World Water Development Report (UNESCO and Berghahn Books, 2003);
• World Health Organization, Right to Water (WHO, 2003).
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Clean Water and Sanitation: Review of The Issue of Water Pollution

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Table of contents

Uses of clean water, causes of water contamination, effects of unclean water, some facts and figures (referred from undp), hook examples for essay on access to clean water.

• A Thirst for Change: Step into the arid landscapes where the lack of clean water threatens lives daily, and explore how access to clean water can be the catalyst for transformative change.
• The Ripple Effect of Clean Water: Delve into the far-reaching impact of clean water access on communities, from improved health and education to economic growth, and understand how this basic necessity can create a wave of positive change.
• Voices from the Wells: Hear the stories of individuals who have struggled without access to clean water and learn about their resilience, highlighting the urgency of addressing this global crisis.
• From Scarcity to Sustainability: Explore innovative solutions and initiatives aimed at ensuring a sustainable future for clean water access, and the role each of us can play in this vital mission.
• The Right to Clean Water: Examine the fundamental human right to clean water, recognized by the United Nations, and consider the ethical and moral imperatives of providing this essential resource to all people worldwide.

Works Cited

• Hutton, G., & Bartram, J. (2008). Global costs of attaining the Millennium Development Goal for water supply and sanitation. Bulletin of the World Health Organization, 86(1), 13-19.
• United Nations Development Programme (UNDP). (n.d.). Sustainable Development Goals: Clean Water and Sanitation.
• United Nations Water. (2019). World Water Development Report 2019: Leaving No One Behind. Paris, France: UNESCO. Retrieved from http://www.unwater.org/publications/world-water-development-report-2019-leaving-no-one-behind/
• Water.org. (n.d.). Water facts. Retrieved from https://water.org/our-impact/water-crisis/water-facts/
• Water for Good. (n.d.). Our impact. Retrieved from https://waterforgood.org/our-impact/
• World Health Organization (WHO). (2019). Water, sanitation and hygiene for accelerating and sustaining progress on neglected tropical diseases: A global strategy 2015-2020. Geneva, Switzerland: WHO Press.
• World Health Organization (WHO). (2021). Progress on household drinking water, sanitation and hygiene 2000-2020: Five years into the Sustainable Development Goals. Geneva, Switzerland: WHO Press.
• World Health Organization (WHO) & United Nations Children’s Fund (UNICEF). (2019). Progress on household drinking water, sanitation and hygiene: 2000-2017. New York, NY: UNICEF.
• World Health Organization (WHO) & United Nations Children’s Fund (UNICEF). (2021). Progress on household drinking water, sanitation and hygiene: 2017 update and SDG baselines. Geneva, Switzerland: WHO Press.
• World Wildlife Fund (WWF). (n.d.). Water scarcity.

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