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DOMESTIC SAFE WATER MANAGEMENT IN POOR AND
RURAL HOUSEHOLDS
by
Lutendo Sylvia Mudau
Submitted in fulfilment of the requirement for the degree
DOCTOR OF TECHNOLOGIAE: ENVIRONMENTAL HEALTH
in the
Department of Environmental Health
FACULTY OF SCIENCE
TSHWANE UNIVERSITY OF TECHNOLOGY
Supervisor: Professor MS Mukhola
Co-Supervisor: Professor PR Hunter
January 2016
i
DECLARATION
“I hereby declare that the thesis submitted for the degree Doctor of Technologiae:
Environmental Health at Tshwane University of Technology, is my own original work
and has not been previously submitted to any other institution of higher education. I
further declare that all sources cited or quoted are indicated and acknowledged by
means of a comprehensive list of references”.
______________________________________
Lutendo Sylvia Mudau
© Copyright 2016Tshwane University of Technology
ii
DEDICATION
I dedicate this study to the Almighty God who knew my plans before I was
born; and gave me strength to pursue my studies so that His plans became
reality;
Brothers and sisters in Christ who never cease to pray for my studies.
My husband Mavhungu Michael; my children Mbofhoyalufuno, Zwivhuya and
Phathutshedzo for their support, patience and encouragement and
My parents Samson Madadzhe and Nkhumeleni Florence Ramulumisi, for
their unceasing prayers and encouragement.
iii
ACKNOWLEDGEMENTS
I would like to express my gratitude and appreciation for the following individuals and
institutions who contributed sincerely to the study:
My supervisor Professor MS Mukhola, you showed me your academic
leadership, guided and motivated me; supported, assisted and picked me up
when I was distressed;
Professor PR Hunter, it was an honour to work with you as one of the world
leaders in water research, thank you for your assistance, supervision and
guidance in statistical analysis as well as during the entire study;
Dr M Letsoalo, thanks for your assistance with management of data and
analysis;
Environmental Health colleagues, thank you for your support and motivation
during my studies;
Mr MM Mokoena, thank you for your assistance during field work, data
collection and data capturing;
Professor JM Ndambuki, for proof reading some of my work;
Professor M Muchie for encouraging me to publish a book chapter based on
my work;
The Tshwane University of Technology and the South African Medical
Research Council for financial assistance and
Wellcome Trust through Scientists Networked for Outcomes from Water and
Sanitation (SNOWS), for capacity building and financial support.
iv
ABSTRACT
Access to safe and reliable water supply is still a major challenge in most rural
households of South Africa (SA). Currently, there is no sustainable way used, in rural
households, for managing risks in water to ensure timeous access to safe water
despite inconsistency of water supply. The study used mixed research
methodologies to investigate the manner in which household water safety is
managed in rural and peri-urban settings and included desktop study review and
observations, group interviews, questionnaires and water quality analysis. The
research intended to answer the main research question “How best can we improve
domestic safe water management in poor and rural areas through policy?”
Desktop study review was used to compare water service indicator’s standards set
internationally and in SA. In addition, a field study comprising of two case studies was
used to obtain data in different village settings of Vhembe District Municipality. The
first case study used group interviews in villages affected by cholera, to establish a
real life status of water safety management practices to see if they were still adhering
to safe water practice measures used during an outbreak. The second case study
used a structured questionnaire to conduct in-depth interviews to explain water safety
management practices in households. The data was supplemented by water quality
studies which looked at faecal indicators microorganisms (total coliforms, E. coli and
enterococci) to establish the safety of the water used. Both case studies used
observations to complement what was reported by the respondents in villages
experiencing water shortages and those with plentiful supply of water.
v
The results of literature review acknowledges that compliance to these indicators is
still a major challenge both internationally and in SA. Though service level indicators
are outlined in the Water Supply and Sanitation Policy White Paper of SA, there was
no methodology used by local authorities to assess its service level against the
standard for early detection of risks in village settings. However, for prevention of
risks in water, Water Safety Plans (WSP) is practiced up to a tap, but not at
household level.
The field studies found that the communities used mixed water sources (river,
springs, tanks, boreholes, private drilled wells and communal taps) due to unreliable
water supply, which makes management of health risks and water safety at
household level very complex. Identification of health hazards which included
intermitted water supply, poor hygiene practices and poor water quality in water
sources and in containers makes communities vulnerable to public health risks. The
results indicated that history of cholera outbreaks or living in villages with scarcity or
plentiful water sources does not influence the communities to manage water safely at
home. The study concluded that safe water management practices in all households
was not practised properly, despite the diverse situations the communities find
themselves in.
WSP for rural communities and assessment of risks through systematic procedure of
household water safety plan; and improvement of water services at domestic level
through policy, could speed up the public health gains thus improving the lives of the
most vulnerable communities in poor and rural households. Therefore, this study
suggests the establishment of simple household WSP to be included in policy with
the aim of improving public health gains in both rural and developing countries.
vi
TABLE OF CONTENTS
DECLARATION .......................................................................... i
DEDICATION ............................................................................. ii
ACKNOWLEDGEMENTS ......................................................... iii
ABSTRACT .............................................................................. iv
LIST OF FIGURES .................................................................. xv
LIST OF TABLES .................................................................. xvii
LIST OF EQUATIONS ............................................................ xix
LIST OF ACRONYMS ............................................................. xx
CHAPTER 1: INTRODUCTION ................................................. 1
1.1 INTRODUCTION TO THE STUDY ........................................................................ 1
1.2 BACKGROUND OF THE STUDY ......................................................................... 4
1.3 RESEARCH QUESTIONS ................................................................................... 8
1.3.1 Primary research Questions ....................................................................... 8
1.3.2 Secondary research questions ................................................................... 8
vii
1.4 STATEMENT OF THE PROBLEM ........................................................................ 9
1.5 PURPOSE OF THE STUDY................................................................................ 10
1.5.1 Primary Objective ..................................................................................... 10
1.5.2 Secondary Objectives .............................................................................. 10
1.6 SIGNIFICANCE OF THE STUDY ........................................................................ 11
1.7 LIMITATIONS ..................................................................................................... 12
1.8 THE OUTLINE OF THE STUDY .......................................................................... 13
1.9 ETHICAL CONSIDERATION ............................................................................. 15
1.10 SUMMARY ........................................................................................................ 16
CHAPTER 2: LITERATURE REVIEW ..................................... 17
2.1 INTRODUCTION ................................................................................................ 17
2.2 CONCEPTUAL FRAMEWORK OF BASIC WATER SERVICE DELIVERY ......... 19
2.2.1 Accessibility ............................................................................................. 20
2.2.2 Availability ............................................................................................... 23
2.2.3 Potability .................................................................................................. 26
2.3 BENEFITS AND LIMITATIONS OF USING INDICATOR BACTERIA FOR WATER
QUALITY ANALYSIS ................................................................................................. 31
viii
2.4 HOUSEHOLD WATER SAFETY AND MANAGEMENT ...................................... 32
2.5 NON-MICROBIAL PARAMETERS ..................................................................... 34
2.5.1 pH ................................................................................................................
2.5.2 Turbidity ................................................................................................... 35
2.5.3 Electrical Conductivity .............................................................................. 36
2.6 QUANTITATIVE MICROBIAL RISK ASSESSMENT OF DRINKING WATER
QUALITY IN HOUSEHOLDS ..................................................................................... 36
2.7 POLICIES AND DOCUMENTS REGULATING BASIC WATER SERVICE
DELIVERY IN SOUTH AFRICA ................................................................................. 38
2.8 AVAILABILITY ASSESSMENT ........................................................................... 44
2.9 ACCESSIBILITY ASSESSMENT ........................................................................ 46
2.10 POTABILITY ASSESSMENT ............................................................................ 49
2.11 GENDER AND HOUSEHOLD WATER SAFETY MANAGEMENT .................... 51
2.12 SUMMARY ....................................................................................................... 52
CHAPTER 3: METHODOLOGY ............................................. 55
3.1 INTRODUCTION ................................................................................................ 55
3.2 THE THEORETICAL FRAMEWORK OF CASE STUDIES METHODOLOGY ..... 56
ix
3.3 DESCRIPTION OF STUDY SETTING ................................................................ 57
3.3.1 Case Study 1 ............................................................................................................. 57
3.3.2 Case study 2 .............................................................................................................. 61
3.4 STUDY DESIGN ................................................................................................. 65
3.5 DATA COLLECTION AND SAMPLING ............................................................... 67
3.5.1 Questionnaire development for case study 1 ............................................................... 67
3.5.2 Case study 1 data collection........................................................................................ 68
3.5.3 Data collection and questionnaire development of case study 2 .................................. 69
3.5.3.1 Data collection plan case study 2 .................................................................. 69
3.5.3.2 Study population and sampling case study 2 ............................................... 70
3.5.4 Consent form ............................................................................................................. 71
3.5.5 Diarrhoea disclosure .................................................................................................. 72
3.5.6 Questionnaire development........................................................................................ 73
3.5.6.1 Questionnaire structure for case study 2 ....................................................... 73
3.6 PILOT STUDY ..................................................................................................... 75
3.6.1 Introduction ................................................................................................................ 75
3.6.2 Background of pilot study setting ................................................................................ 75
3.6.3 Fieldwork procedure for pilot studies .......................................................................... 76
3.6.4 Questionnaire adjustment .......................................................................................... 77
3.7 DATA COLLECTION CASE STUDY 2 ................................................................. 78
x
3.7.1 Household survey ....................................................................................................... 78
3.7.2 Water quality assessment .......................................................................................... 78
3.7. 2.1 Detection of physical parameters ................................................................. 79
3.7.2.2 Detection of microbiological parameters ....................................................... 80
3.8 DATA ANALYSIS ................................................................................................ 81
3.8.1 Case study 1 data analysis ......................................................................................... 81
3.8.2 Case study 2 data analysis......................................................................................... 81
3.9 SUMMARY ......................................................................................................... 82
CHAPTER 4: RESEARCH FINDINGS .................................... 84
4.1 INTRODUCTION ................................................................................................ 84
4.2 DEMOGRAPHIC COMPOSITION OF THE STUDY ............................................ 85
4.3 DESCRIPTION OF WATER SERVICE LEVEL IN EACH VILLAGE ..................... 91
4.3.1 Type of water sources used and availability ............................................. 91
4.4 HOUSEHOLD WATER TREATMENT ................................................................. 99
4.5 CONTAINER HYGIENE .................................................................................... 100
4.6 CONTAINER CLEANING METHODS ............................................................... 104
4.8 CONDITION OF HYGIENE IN PLACES WHERE WATER IS STORED ............ 106
4.9 ACCESSIBILITY OF HOUSEHOLD WATER SOURCES .................................. 109
xi
4.10 DISTANCE FROM HOUSEHOLD TO WATER SOURCES ............................. 110
4.11 TRIPS TO WATER SOURCES ....................................................................... 112
4.12 HEALTH EDUCATION AND COMMUNICATION RELATED TO WATER
SERVICE ................................................................................................................ 113
4.13 WATER QUALITY ........................................................................................... 115
4.14 PHYSICAL PARAMETERS............................................................................. 115
4.15 MICROBIOLOGICAL QUALITY OF DRINKING WATER SOURCES AND
WATER STORED IN CONTAINERS. ...................................................................... 121
4.16 SUMMARY ..................................................................................................... 129
CHAPTER 5: DISCUSSION .................................................. 131
5.1 INTRODUCTION ................................................................................ 131
5.2 WATER SOURCES, ACCESSIBILITY AND RELIABILITY OF WATER SERVICE.
................................................................................................................................ 131
5.3 DRINKING WATER QUALITY .......................................................................... 135
5.4 CONTAINER HYGIENE AND ENIVIRONMENTAL CONDITIONS OF
HOUSEHOLDS ....................................................................................................... 140
5.5 COMMUNICATION OF RISKS IN WATER AND TREATMENT ........................ 143
5.6 SUMMARY ....................................................................................................... 147
xii
CHAPTER 6: HOUSEHOLD WATER SAFETY PLAN ......... 149
6.1 INTRODUCTION .............................................................................................. 149
6.2 OVERVIEW OF THE HOUSEHOLD WATER SAFETY PLAN ........................... 150
6.3 DEFINITION OF WATER SAFETY PLAN AND RISKS ASSOCIATED WITH
HOUSEHOLD WATER SUPPLY ............................................................................. 156
6.4 HOUSEHOLD WATER TREATMENT AND STORAGE ANALYSIS AND RISK
ASSESSMENT ........................................................................................................ 158
6.5 THE PROCESS OF THE HOUSEHOLD WATER SAFETY PLAN ..................... 164
6.6 RISK ASSESSMENT OF WATER SERVICE LEVEL INDICATORS .................. 164
6.7 RISK ASSESSMENT OF HOUSEHOLD WATER ........................................ 169
6.8 HOUSEHOLD WATER SAFETY PLANS .................................................. 172
6.9 SYSTEMETIC APPROACH OF HOUSEHOLD WSP IN RURAL HOUSEHOLDS ...
................................................................................................................... 173
6.10 PREREQUISITE ASSESSMENT AND FORMULATION OF A TEAM 173
6.11 ON-SITE RISK ASSESSMENT ............................................................ 174
6.12 HAZARD ANALYSIS AND CONTROL MEASURES ................................... 175
6.13 SIMPLIFIED HOUSEHOLD WSP FOR RURAL HOUSEHOLD .................... 175
xiii
6.14 SUMMARY ..................................................................................................... 180
CHAPTER 7: CONCLUSION AND RECOMMENDATIONS . 182
7.1 INTRODUCTION .............................................................................................. 182
7.1.1 Desktop study Review ........................................................................... 182
7.1.2 Case study 1 ......................................................................................... 184
7.1.3 Case study 2 ......................................................................................... 185
7.1.4 Household Water Safety Plan ................................................................ 188
7.2 CONCLUSION .................................................................................................. 189
7.3 STRENGTH AND WEAKNESSES OF THE STUDY ......................................... 190
7.4 RECOMMENDATIONS .................................................................................... 191
7.5 FUTURE RESEARCH STUDIES ...................................................................... 192
REFERENCES ....................................................................... 194
APPENDICES ........................................................................ 228
APPENDIX A: RESEARCH QUESTIONS (CASE STUDY 1) .................................. 229
APPENDIX B: HOUSEHOLD SURVEY QUESTIONNAIRE (CASE STUDY 2) ......... 237
APPENDIX C: ETHICS APPROVALS ..................................................................... 261
xiv
APPENDIX D: PROVISIONAL INFORMED CONSENT FORM ................................ 265
APPENDIX E: TYPE OF WATER SOURCES USED AS PER SOCIO-ECONOMIC
STATUS-WATER SOURCES ................................................................................. 270
APPENDIX F: WATER AVAILABILITY AS PER SOCIO-ECONOMIC STATUS ...... 271
APPENDIX G: PERIOD WHEN COMMUNAL WATER WAS AVAILABILITY AS PER
SOCIO-ECONOMIC STATUS ................................................................................. 272
APPENDIX H: ENVIRONMENTAL HYGIENE PRACTICES IN HOUSEHOLDS AS
PER SOCIO-ECONOMIC STATUS ......................................................................... 273
APPENDIX I: CONTAINER HYGIENE AS PER SOCIO-ECONOMIC STATUS ....... 274
APPENDIX J: CONTAINER CLEANING METHODS AND PRIOR USE AS PER
SOCIO-ECONOMIC STATUS ................................................................................. 275
APPENDIX K: HOUSEHOLD WATER SOURCES AND TREATMENT AS PER
SOCIO-ECONOMIC STATUS ................................................................................. 276
xv
LIST OF FIGURES
Figure 3. 1: Map of Nwanedi Area (Oxi explorer maps 2010) ................................... 58
Figure 3. 2: River water used for drinking purposes .................................................. 58
Figure 3. 3: Communal water collection point ........................................................... 60
Figure 3. 4: Sinthumule and Tshifhire study areas (Google maps, 2010).................. 62
Figure 3. 5: Sinthumule setting and distribution of private drilled water tanks ........... 63
Figure 3. 6: Communal water collection point- Sinthumule village ............................ 63
Figure 3. 7: Tshifhire setting ...................................................................................... 64
Figure 4. 1: Water source types used by the groups within study area (n=21) .......... 92
Figure 4. 2: Cumulative frequency (%) of unavailable water supplies (yard etc. water
sources) .................................................................................................................... 99
Figure 4.3: Travelling distance to Primary water sources (0.00-household percentage;
0-10m travel distance and Yard etc. water sources) ............................................... 111
Figure 4. 4: Travel distance from households to water sources using independence-
Sample Kruskal-Wallis test. (1.00 (0-10m), 2.00(>10m≤50m), 3.00 (>50m≤100m),
4.00 (>100m≤200m) and 5.00(>200m) .................................................................... 112
Figure 4. 5: Scatter plot of pH measurement between the water source used in
households and water stored inside the container .................................................. 117
Figure 4. 6: Scatter plot of turbidity measurement between the water source used in
households and water stored inside the container .................................................. 118
Figure 4. 7: Scatter plot of Electrical conductivity measurement between the water
source used in households and water stored inside the container .......................... 119
xvi
Figure 4. 8: Independent-Sample Kruskal Wallis Test of Water Sources
Contaminated with total Coliforms. (box- 25th centile, 0- out layers, * extreme out
layers). .................................................................................................................... 125
Figure 4. 9: Independent- Sample Kruskal Wallis Test of water sources contaminated
with E. coli. (box- 25th centile, 0- out layers, * extreme out layers). ....................... 126
Figure 4. 10: Independent- Sample Kruskal Wallis Test of water sources
contaminated with enterococci. (box- 25th centile, 0- out layers, * extreme out layers).
................................................................................................................................ 127
Figure 4. 11: Proportion of drinking water counts with enterococci counts in drinking
water sources .......................................................................................................... 128
xvii
LIST OF TABLES
Table 2. 1: Comparative analysis of basic water access and availability indicators
between international and South African standards. ................................................. 21
Table 2. 2: Water quality indicators based on both International (WHO, 2008) and
DWA, 1998; South African Bureau of Standard, 2011) ............................................. 28
Table 2.3: Strategic documents and legislations on basic water service delivery in
South Africa ............................................................................................................... 42
Table 2. 4: Availability scores (Based on measurement shown in DWA, 1994) ........ 45
Table 2. 5: Accessibility score (Based on measurement indicated by DWA, 1994) .. 49
Table 2. 6: Potability score (Adapted from WHO/UNICEF, 2012) ............................. 50
Table 4. 1: Demographic composition and water service level of study area: case
study 1 ....................................................................................................................... 86
Table 4. 2: Demographic information of case study 2 ............................................... 90
Table 4. 3:Household water sources available at Sinthumule and Tshifhire villages 94
Table 4. 4: Water service level of study area: Case study 2 ...................................... 96
Table 4. 5: Water service level of study area: case study 2 ...................................... 98
Table 4. 6: Unavailability of water in sources ............................................................ 98
Table 4. 7: Container hygiene inside and outside ................................................... 102
Table 4. 8: Hygiene condition of containers as per socio-economic status ............. 103
Table 4. 9: Container’s prior use ............................................................................. 104
Table 4. 10: Container cleaning methods ................................................................ 105
xviii
Table 4. 11: Frequency (%) of cleaning water Tanks connected to a Private Drilled
Well ......................................................................................................................... 106
Table 4. 12: Condition of place where water is stored ............................................. 107
Table 4. 13: Condition of hygiene where water is stored according to socioeconomic
status ....................................................................................................................... 108
Table 4. 14: Distance travelled to water source ...................................................... 110
Table 4. 15: Types of communication provided to the communities ........................ 114
Table 4. 16: pH, turbidity and conductivity measurements in drinking water sources
................................................................................................................................ 116
Table 4. 17: One-way ANOVA output between physical parameter in water sources
................................................................................................................................ 120
Table 4. 18: Concentration of microbiological counts in water sources ................... 123
Table 4. 19: Concentration of microbiological counts in container water ................. 124
Table 6. 1: Scoring matrix of risks outlined by (WHO, 2011) ................................... 161
Table 6. 2: Preliminary and onsite Hazard analysis of household drinking water,
adapted from Pérez-Vidal et al., (2013)................................................................... 167
Table 6. 3: Risk assessment matrix in household water Adapted from Pérez-Vidal et
al., (2013) ................................................................................................................ 168
Table 6. 4: Checklist for Household WSP- Pre-requisite assessment- .................... 178
Table 6. 5: Checklist for household drinking water-onsite assessment ................... 179
xix
LIST OF EQUATIONS
Equation 2. 1: Formula determining volume of water accessed by each person in
household. ................................................................................................................. 44
Equation 2. 2: Relationship between the proportions of population travelling a
distance of <or >200m to collect water [Based on measurement indicated in 1994
White Paper on Water Supply and Sanitation Policy (DWA1994)] ............................ 47
xx
LIST OF ACRONYMS
ANC- African National Congress
ANOVA- Analysis of Variance
CFU-Colony-forming Unit
DALY- Disability-Adjusted Life Year
DoH- Department of Health
DWA- Department of Water Affairs
E. coli- Escherichia coli
EPA- Environmental Programme Agency
GIS- Geographical information System
GPS-Global Positioning System
HACCP- Hazard Analysis Critical Control Point
JMP- Joint Monitoring Programme for Water Supply and Sanitation
km- kilometre
ℓ- litre
ℓ/c/d-Litres per capita per day
L95% CI- Lower 95% confidence Interval
m- metre
NTU- Nephelometric Unit
POU- Point Of Use
PRH- Poor and Rural Households
xxi
QMRA- Quantitative Microbial Risk Assessment
RDP- Reconstruction and Development Programme
SA- South Africa
SANS- South African National Standards
SD- Standard Deviation
UNICEF- United Nations Children Funds
USGS- United states Geology Survey
WHO- World Health Organization
WSA’s-Water Service Authorities
WSP-Water Safety Plans
1
CHAPTER 1: INTRODUCTION
1.1 INTRODUCTION TO THE STUDY
Access to safe drinking water is a formidable challenge in most developing countries
especially in poor and rural areas. About 6 to 9 million people are dying annually due
to water-related diseases (United Nations [UN], 2013a), World Health Organisation
[WHO] United Nations Children’s Fund [UNICEF] (WHO/UNICEF, 2012a).
Furthermore, the majority of these people reside in developing countries with
inadequate water and sanitation service. Rural areas have a high number of people
without access to safe water as compared to urban areas (United Nations, 2013a).
Most of these communities find themselves travelling long distances and spend long
hours in fetching water (Nnaji, Eluwa & Nwoji, 2013). Hence, often that collected
water is unsafe and of public health risks.
The key reasons for providing safe domestic water supply in poor and rural
households are to improve their health, hygiene and welfare, which may also lead to
economic improvement (Verhagen, 2004). Unfortunately, these requirements are still
a dream in rural communities. Consequently, the primary objective for providing safe
domestic water supply is to prevent health risks associated with waterborne diseases
(WHO, 2007).
2
In most countries where water access is a challenge, there are programmes that aim
at the improvement of water services that provide a sufficient volume of safe drinking
water in a sustainable manner to consumers at different points of use (Tanzania
Water Aid, 2009). However, in SA Water Supply and Sanitation Policy White Paper
was developed in 1994 to address the backlog of water and sanitation services that
existed prior to dispensation of a democratic government (Department of Water
Affairs [DWA], 1994). The policy described the manner in which Water Service
Authorities (WSA’s) should provide water services. It further benchmarked water
services using measurable indicators’; namely: potability, availability and accessibility
(Jagals, 2006, Department of Water Affairs [DWA], 1994). However, the delivery of
water services is currently facing many challenges due to poor and unsatisfactory
service rendered to the communities (Tapela, 2012). Subsequently, this lead to
community unrests as the volume of water delivered to the households is usually not
sufficient for household use.
Despite the availability of policy, the main reasons contributing to lack of access to
safe water in SA include unreliable water supply and lack of capacity in rendering the
sustainable services by the WSA’s (DWA, 2010a). The study conducted by Rietveldt,
Haarof & Jagals (2009), found that some of the Poor and Rural Households (PRH) in
SA, have difficulties with accessing sufficient volumes of potable water because of
the unavailability of a basic water service as well as poor maintenance of
infrastructure and operations in areas where such infrastructure is available. Most of
these communities resort to various unmonitored water sources such as unprotected
springs, wells and rivers (Jagals, 2006; Evans et al., 2013).
3
Even in areas where there is water services, connections of tap water are often not
delivered into the dwellings but to communal standpipes outside houses; otherwise
requiring households to traverse water to some distances from these supply points
(taps) with plastic containers to collect and then store the water at home for domestic
use. This situation is shown to adversely affect the health-related microbial quality of
the water kept in such closed containers (Trevett et al., 2005; Jagals, Jagals &
Bokako, 2003; Joubert, Jagals & Theron, 2003). Apparently posing risks of disease
outbreaks associated with acute diarrhoea such as cholera. Consequently,
inadequate safe water supply and unhygienic environment being the main
contributory factor of the disease (WHO, 2006).
The emergence of waterborne disease such as cholera in rural areas of Vhembe
District Municipality (VDM) and other areas in Limpopo Province, where water
services was available; was linked to poor hygiene caused by inadequacy of water
and sanitation services as well as poor access to safe water (DWA, 2009a). A major
factor linked to outbreaks of this nature was lack of knowledge amongst households
on the safe way of managing their water for domestic use in situations where access
to unsafe water was the only option (Department of Health [DoH], 2009).
4
1.2 BACKGROUND OF THE STUDY
The domestic safe water management in PRH setting in terms of hygiene play a
major role in the transmission pathways of acute diarrhoea (Hunter, Toro & Bartram,
2010). However, collection of water and its delivery at household level create
challenges of contamination at the point of use (POU), unlike the water accessed
from safe sources (Hunter, Jagals & Cameroon, 2009; Clasen, 2010). The factors
that contribute to contamination of clean water include the use of dirty containers
stored in unhygienic manner; storing water at the dirty environment which is dusty;
and dipping dirty hands in drinking water; as well as using dirty cups to scoop water
for drinking purposes (Trevett et al., 2005; Clasen, 2006; Brown, 2008; Gundry et al.,
2006). However, the challenge is that there is less effort made in reduction of
contamination of water at the POU within the households in most rural areas of SA.
Most of the focus dwells on the point of collection, which is usually at the tap. Such
practice could be of challenge, as early detection of risks at the POU within the
households is not present.
To prevent such risks, the WHO developed the Water Safety Plan (WSPx) that is
used to identify risks in water before it reaches the consumer (WHO, 2005). The
main objective of this safety plan is to discourage the detection of risks at the point of
water supply. However, WSP is the only acceptable way for early detection of risks
for effective safe water management and control. As a way to improve safe water
supplies, WSP is the first step to mitigate the risks in water sources that could reduce
the public health gains to the consumers (WHO, 2009). Since its inception, most of
5
the countries including SA have adopted WSP as part of their risk assessment
strategy to ensure the provision of safe water up to the tap. The concept is of
beneficial to those who access water through multiple taps within their households.
Therefore, rural communities that access water outside their households could have
some challenges in maintaining safe water provided due to re-contamination that
could occur at the POU.
The introduction of incentive-based Blue Drop Programme in 2008 (DWA, 2009b) is
regarded as the key performance indicator in provision of safe water to the
communities by WSA’s. Blue Drop Programme regards safe water as the one in
which E. coli should be <1/100mℓ to avoid acute illness according to South African
National Standard [SANS] 241-2011 (South African Bureau of Standard [SABS],
2011). However the performance base targets suggest that there should be at least
95% compliance of all water sources under excellent category; 93% good and less
than 93% of unacceptable drinking water quality in water sources (Swart, 2014).
Subsequently, 95% compliance of water system in water represent the effectiveness
of Blue Drop process and safe water provision to the public.
The purpose of this regulation is to introduce the holistic approach of WSP in drinking
water and provision of a systematic, transparent approach to consistently provide
safe water for public health gains. Since its inception in 2009, there was a noticeable
progress in terms of compliance in the provision of potable water. In the past years
between 2009 to 2011 the average Blue Drop score in SA WSA’s was 51.4% (n=107)
(2009), 67.2% (n=153) (2010) and 72.9% (n=162) (2011) respectively for the
assessed WSA’s (DWA, 2009c; DWA, 2010b; DWA, 2011). Therefore, this suggests
6
an improvement in compliance with water safety regulations during that period and
commitment of the SA government in providing safe water to its communities.
The prevention of health risks at household level is the main aim of practicing water
safety management in water systems available in various parts of SA including
Limpopo Province. The involvement of municipalities in the province is the first step
towards showing commitment to the provision of potable water to the communities.
In 2011 Blue Drop Assessment outcomes indicated that a total of 64 water systems
were assessed in Limpopo Province and the scores ranged from 40,82% (2009c),
54,9% (2010) and 64% (2011) respectively; while in 2012 report, 74.9% systems
compliance was recorded. However, VDM is one of the municipalities that always
took part in the WSP assessments that took place every year since 2009 (DWA,
2012). Since 2009, the average Blue Drop Assessment score was 45, 06%.
Whereas in study areas, Blue Drop score of 2011 at Tshifhire treatment plant was at
43.65% and at Sinthumule 21,03% was recorded (DWA, 2011). The outcomes of the
assessment further indicated that there was no consistent monitoring of water
sources at Sinthumule area by the district; hence, there was also a lower level of
compliance in drinking water quality. This could be due to inconsistent availability of
water at the area (Nengovhela, 2006). Whereas at Tshifhire, monitoring was
consistent but water quality was not sustained (DWA, 2011).
Both results in these two areas show that there are factors that pose a public health
threat for drinking water quality that was reported not safe. Consequently, due to the
set-up of the area, quality of water could deteriorate further if the collection of water
7
occurred on the street tap and stored in containers at the households for later use.
However, ensuring household water safety to the POU is not part of the Blue Drop
performance. As such, the good intension of policy to provide reliable safe water
become ineffective due to likelihood of water contamination during collection,
transportation, storage, and use from domestic water containers (Beumer et al.,
2002).
Water Supply and Sanitation Policy White Paper of 1994; in SA does not address
issues of risk assessment to ensure water safety at the POU (DWA, 1994). The
focus is mainly on basic water supply to the public i.e. up to the point of delivery,
which in poor and rural communities often accessed on the street and not in the
household. There is a definite gap in the policy on safe water management in a
domestic setting from the point of collection to storage and consumption. Ultimately,
the users manage water issues on their own in terms of both quantity and quality.
WHO/UNICEF (2012c) indicated that this challenge could be better managed by the
development and implementation of the Household Water Treatment and Storage
(HWTS) strategy that could also have a positive contribution in the formulation of
household water policy by 2015. This recommendation could be effective if WSA’s
could adopt the household water safety plan to address various household water
safety risks associated with the deterioration of water quality at the POU.
Subsequently, the use of environmental health education should be the major issue
to improve health literacy among rural communities. It is therefore the intention of
this research to demonstrate how best can the water at the POU be safely managed
8
in PRH settings in the Vhembe district of the Limpopo Province and the way in which
domestic safe water management can be addressed through policy instruments.
1.2 RESEARCH QUESTIONS
1.3.1 Primary research question
To address the purpose of the study as outlined in 1.5 the primary research question
observed was “How best can we improve domestic safe water management in
PRH through policy?”
1.3.2 Secondary research questions
Out of the primary research questions, identified secondary questions were as
follows:
What are the policy implications on basic water service level in rural households
of South Africa as compared to international water service standard indicators?
To what extent does cholera outbreaks changes the way in which rural
communities manage their household water?
What are the current household water services and practices in peri-urban areas
of South Africa?
What is the status of drinking water quality used in households?
What are the steps followed to develop a household water safety plan?
How does a household WSP inform drinking water policy?
9
1.4 STATEMENT OF THE PROBLEM
Unsafe water is a global challenge that account to 88% of acute diarrhoea
prevalence (WHO/UNICEF, 2009). The challenges of inadequate provision of
sustainable potable water in rural areas including SA, lead to an increased number of
children with diarrhoea due to unsafe water used when potable water is not available.
Diarrhoea is the leading cause of death in children under the age of five in SA
(Census, 2014). However, various intervention studies using different water
treatment methods at the POU, improved the state of health in most developing
countries where disease outbreaks occurred. However, it is unfortunate that up to
now, there is no single method used that could sustain total effectiveness of water
safety at the POU; as it is highly dependent on the way in which individuals manages
water at household level.
The way in which domestic water is managed in a PRH setting in terms of hygiene
play a major role in the transmission pathways of acute diarrhoea (Hunter, 2009a).
Environmental health education on safe storage of water and treatment are amongst
some of the household water safety management to curb the continuation of
outbreaks in developing countries (WHO/UNICEF, 2012; South African Government
Communication Information System, 2008). The main challenge is that few days
after the outbreaks people go back to their original unhygienic environmental health
practices. The behaviour similar to these could mean failure to understand the
importance of safe water management; which in a way indicates poor health literacy
and inability of the community to invest in their own health. Water Supply and
10
Sanitation Policy White paper of 1994 in SA does not address the issue of safe water
and risk management at household level but its focus is currently at the point of
delivery (DWA, 1994). It is therefore, the intention of this study to outline the need for
holistic approach i.e. WSP at household level supported by education on
environmental health practices.
1.5 PURPOSE OF THE STUDY
1.5.1 Primary Objective
The main objective of the study is to assess environmental health practices related to
current domestic water management in PRH and the extent to which policy could
address the impact of these risks.
1.5.2 Secondary Objectives
To review and to make comparisons between international countries and SA on the
current situation on basic water service level associated with household water
management;
To determine basic level of household water management practices following an
outbreak of cholera in rural areas of Limpopo province;
To scrutinise households on domestic water quality and practices and
To develop household water safety plan.
11
1.6 SIGNIFICANCE OF THE STUDY
Household water safety management is crucial and has become the most popular
topic under discussion in the world recently; due to the cases of diarrhoea that are
not decreasing for the past few years (WHO/UNICEF, 2009b). Hence, 88% of the
world diarrhoeal cases are preventable according to WHO (2007). It should be noted
that the world is changing its focus from water system coverage to the improvement
of water safety at the POU through HWTS. A target of 30 more countries to develop
HWST policy by 2015 has been set to show commitment in improving water safety in
households (WHO/UNICEF, 2012c). Therefore, this study focuses on the contribution
to the life of South Africans in the following ways:
The study on domestic water management will outline what is currently happening
in some parts of SA to bring new ideas on the prevention of acute diarrhoeal
disease in rural and poor households;
The study presents a need for the shift in focus from national to local water
management especially at the POU in household level to improve the public health
gain;
The research will assist various spheres of government from the national to local
level to realize the need for improved water service and water safety management
in household inclusion in the policy as another way to prevent acute diarrhoea
diseases;
The municipal health service and National DoH makes an informed decision on the
way in which safety of water could be streamlined into their policies, monitored and
managed at household for public health gains in communities;
12
Most importantly, the development of a household WSP will give the decision makers
an opportunity to include household water safety issues in their policy reviews. That
could lead to ensuring that rural and poor communities manage their own health
through application of the appropriate knowledge on the prevention of acute
diarrhoea.
1.7 LIMITATIONS
The study was conducted in the Limpopo Province in VDM only. Although there were
two case studies done, the number of households’ surveys conducted was limited
and focused to one district. There is a need to conduct such studies to other areas in
SA with an even larger sample size to determine the situation in other provinces.
Time constraints and funds are construed as two of the limitations to covering a large
sample. In case study 1, a convenient sampling was used limited to the number of
participants available by the time of the study. The purpose was to get the
information as it happens. In case study 2, most households could not respond to
health related questions as some of them linked diarrhoea with HIV/AIDS. Some of
the household’s members did not even want to talk about their income and personal
hygiene. Efforts were made to approach the same household using unknown field
workers and the strategy worked as the response rate improved. Despite the
improved data on diarrhoea, the level of diarrhoea prevalence was too low to
supplement the data obtained from the households. Although health data in
households could not be reported, the supplementary information was considered
sufficient to support the stated conclusions. The findings on poor safe water
13
management and contamination of drinking water used in households suggested that
the communities were at risk.
1.8 THE OUTLINE OF THE STUDY
This section presents the overall summary of the organisation structure of the thesis.
The thesis is characterised by seven Chapters outlined as follows:
Chapter 1: Presents the introduction and background of the entire study. The
Chapter introduces what the study is all about (that is (i.e.), the background, research
problem and the objectives).
Chapter 2: Presents an extensive literature review on management of household
water and risk assessment of drinking water. Policy implication on basic household
water service level and indicator standards internationally and in SA also outlined.
The Chapter closes by identifying gaps related to domestic safe water management.
Chapter 3: Presents the methodology of the study and description of case studies
done. The study used both qualitative and quantitative methods that included
observations, group interviews, questionnaires and water quality analysis to
determine the way in which the communities managed their drinking water.
Chapter 4: The Chapter presents the results and interpretation for all case studies.
The findings include demography of the areas of investigations, the water service
level, environmental health practices in relation to drinking water used in households,
community behaviour after cholera outbreak, reliability of water sources and water
quality analysis. The results will bring an overview on how management of drinking
14
water from the point of collection, household storage point and at the POU is done.
The water quality results will bring evidence of the area of risks identification; at the
point of collection or at the POU.
Chapter 5: Discusses the study based on the findings in Chapter 4. The discussion
is based on the outcomes of water service level in each area and the way it linked
with the demography outcomes of the study. Discussions also include hygiene
assessment, sources used, household water practices, and water quality outcomes
from the source to the POU. The discussion outlines the gaps in household water
safety management and relates the findings to desktop studies in Chapter 2.
Chapter 6: Suggests ways of managing risks through household water safety plan
based on the results and discussion in Chapter 4 and 5 supported by desktop study
review in Chapter 2 to indicate contributions to a new knowledge brought by the
study. The cross-reference in this chapter led to the formulation of a household
water safety framework and plan that indicates a systematic way of conducting risk
assessment of drinking water used, from the water collection point (tap) to the POU.
This Chapter also established a simple household WSP for rural areas; and suggests
inclusion of policy framework on household water safety management in water quality
related policy.
Chapter 7: Arrives at conclusion and makes recommendations. In general, Chapter
7 highlights the overall conclusion on the status of the domestic safe water
management in SA and determination of the need to include it in the policy. The
establishment of whether the research questions and the objectives are achieved
was also outlined in this Chapter. Finally, the Chapter made recommendations to
highlight weaknesses and strength of the study; and concluded by outlining further
15
studies needed to improve household water safety as part of local water safety
management.
1.9 ETHICAL CONSIDERATION
Ethics approval was duly obtained from the Tshwane University of Technology
(TUT), by Research Ethics committee (see Appendix c); for collection of data
in relation to case study 1. The following approvals were obtained for case
study 1 and 2:
Case study 1 was based on the baseline questions from toolkit instrument as
attached in Appendix C;
Permission From the Sinthumule tribal authorities and the TUT Research
Ethics committee (see Appendix C);
Consent to conduct study was obtained from the participants prior to any data
obtained;
Tshwane University of Technology (TUT) Research Ethics Committee
approved on the basis of the approval of the data collection tool (questionnaire
and observations involving households) as well as informed consent forms
used to recruit households. Formal work did not commence before the final
approvals were granted (see attached Appendix C);
16
1.10 SUMMARY
The Chapter outlines the introduction and background of the entire study. The study
on household water safety management focuses on the scrutiny of current water
service and the way in which WSA’s respond to the indicators stipulated in the Water
and Sanitation Policy White Paper. The main objective is to minimize water related
diseases and outbreaks. The study follows the idea of WSP and Blue Drop, which
focuses on the early detection of risks in water from the source to a point of
collection. Hence, this study addresses early detection of risks from the point of
collection to a POU at household level. The Chapters stipulated in section 1.8 of this
document tried to scrutinize the way in which water safety management practices in
households from both improved and non-improved sources is done.
The study was arranged in the form of case studies on the basis of which issues such
as environmental health practices related to water management, water quality
assessment from the source to the POU and continuous environmental health
practices to safe water management by communities after an outbreak of cholera are
discussed. The outcomes for the study will indicate if there is a need for water safety
management at household level. The new ideas emanated from this study will be of
value to policy decision makers towards the prevention of acute diarrhoeal disease in
rural and poor households. Most importantly, rural and poor communities will be able
to manage their own health through the application of the appropriate knowledge on
how to prevent acute diarrhoea to improve public health gains.
17
CHAPTER 2: LITERATURE REVIEW
2.1 INTRODUCTION
Although it is the right of every human being to access water supply which is
sustainable, affordable and safe (United Nations (2013a), 760 million people
worldwide are still living without potable water (WHO/UNICEF, 2012a). The United
Nations’ Millennium Development Goal (MDG) requires every country to half the
number of people without access to water and sanitation by 2015 (United Nations,
2005a). Currently more than 50% of countries worldwide have reached the target,
although Sub-Saharan countries are still at 47% (WHO/UNICEF, 2012a). South
Africa (SA) is counted amongst those countries which reached the target by
providing 93% of its communities with access to water services (WHO/UNICEF,
2012b).
Despite this achievement, the disparities of water access and availability between
urban and rural communities are still a formidable challenge (Water Research
Commission, 2012). Worldwide, urban areas tend to have a more sustainable water
supply than rural areas (United Nations, 2013a). Since the beginning of MDG, the
poor were known to be the ones who suffered and were associated with unsafe
water supply. This is one of the reasons why most rural communities spend a great
deal time collecting water far away from their households, while most of those living
in urban areas enjoy the benefits of having tap water in their yards (Boone, Glick &
Sahn, 2011). People living in urban areas are often provided with acceptable water
services, while rural and informal settlements have low access to water services
18
(Hosking & Jacoby, 2013), as provision of water services in these areas is prioritised
based on economic well-being of the area where they are residing. Most rural and
informal settlement communities do not enjoy such privileges because frequent
water supply remains a big challenge.
United Nations Human Rights encourage each country to develop policies which
ensure that water supply services are provided to all (United Nations, 2013b). The
SA government realised such rights long before, as indicated in the constitution,
stating the right to safe water supply as a mandate for each local municipality to
provide such services (SA Constitution Act, 1996; SA Water Service Act, 1997). The
White Paper on Water Supply and Sanitation Policy from the DWA (1994), explains
how water services should be provided. It is stated in this policy, that any water
service rendered should be accessible, available and potable (DWA, 1994). These
three concepts are regarded as the main conceptual framework to measure the level
of basic water service delivery in each WSA in SA. Indicators of these concepts
clearly show that 25 litres (ℓ) of water should be available daily to every individual
within 200 metre (m), at a flow rate of 10ℓ per minute.
To enhance affordability, free basic water regulation was set and based on these
indicators (DWA, 2002): The first 6000ℓ is provided free of charge to the poor,
calculated using households with eight members who should receive 25 ℓ/c/d (litres
per capita per day) for 30 days (DWA, 2002). The measurement was based on the
quantity of water which needs to be accessed by each member of the household per
day, as a basic water service level. Where such indicators are not met, water
19
service delivery is taken as being compromised; and unfortunately most of WSA’s in
SA do not meet such requirements (Smith, 2010).
Currently in SA, there is no methodology to quantify access to basic water services
provided by WSA’s, as benchmarked by these indicators, especially in small-
localised rural areas where water is accessed outside the compound. It is the
purpose of this review to come up with a rapid methodology to estimate and quantify
water accessed by a community in a village, local Municipality or WSA’s and
benchmarked against the indicators that measure basic water service delivery and
the risks that could be associated with it. Where adequate water supply cannot be
maintained, WSP at household level should be employed, supported by continuous
education for the affected communities. The main question will be how the WSA’s
can quantify risks using indicators as a way of measuring its own service delivery in
rural communities.
2.2 CONCEPTUAL FRAMEWORK OF BASIC WATER SERVICE DELIVERY
The key issue in measuring basic water service delivery in SA is to access
continuous water supply in households without attaining any health risks. To meet
such requirements the water service should be available (water quantity), accessible
(distance travelled and time) and potable (drinkable and acceptable microbial water
quality). Once these requirements are met community risks become minimal. The
use of these concepts to measure basic water service delivery was made to WSA’s
to measure performance when infrastructure is provided (Smith, 2010). This could
20
assist in rating the water service delivery efficiency, effectiveness and its
sustainability. Detailed analysis of each concept is discussed below.
2.2.1 Accessibility
Howard and Bartram (2003) describe accessibility of water service as the time spent
to travel and arrive at the water source and bringing potable water back to the
household as outlined in Table 2.1. However, they further indicated that every
household should have access to 20ℓ volume of water within a range of 1km in 30
minutes. The 1km radius is seen as unacceptable by other authors due to the time
spent, which is possibly more than 30 minutes, as it could be influenced by many
factors such as the route used, queuing time and well-being of the person collecting
water (Mansour, 2011). This international standard does not include the flow rate as
its standard is not limited to only one system used, as compared to SA. Dar and
Khan (2011) outlined some of the gaps related to the indicator as it does not
consider the route used, the queuing time as well as the system used to access the
water. Based on the analysis the study indicated the need for indicator’s review so
that the decision makers could be fully informed.
SA based its White Paper policy standard on tap water (DWA, 1994). This policy
outlined basic water delivery as the access to 25ℓ of water within 200m; the average
time related to this indicator is not specified as is the case with international
standards. The review by Wang and Hunter (2010) indicated that the
21
environmental impact caused by the long distance to access water is unclear, but
there might be the probability of risk factors which will require more studies to
confirm the statement.
Table 2. 1: Comparative analysis of basic water access and availability indicators between international and South African standards.
SA is one of the countries with the highest achievement in terms of MDG level on
providing its communities with access to safe water, when compared to other African
countries. The infrastructure coverage was reported to be 97%, though the figure
International water accessibility indicators Description SA water accessibility indicators
Water Service level
Distance and time spent on water collection
Water volume available per capita per day
References Description of Household water service outcomes(SA and international indicators)
One-way water collection distance and time spent.
Estimate water volume available per person in the household
References
Bad water service delivery
>1000m
>30 minutes
<7.5 ℓ/c/ d
(Bartram & Howard, 2003; Sphere project, 2004)
Risk of utilising unsafe water sources
>200m
time not specified
<10 ℓ /c/d DWA, 2010
Acceptable basic water service
≤1000m
≤30 min
20 ℓ/ c/d Bartram & Howard (2003)
Acceptable basic household water required with minimal risk.
<200m
time not specified
25 ℓ /c/d DWA, 1994
Good water service for all
Household water connection available in the yard.
50-60ℓ /c/d
Bartram & Howard (2003)
Preferred household water that each person should access daily - low risk
50 ℓ /c/d 50 ℓ /c/ d
DWA, 2010
Excellent water service
More than one water connection within the household
100-30ℓ /c/d
Howard & Bartram, 2003; Moriarty et al., 2011
Outstanding household water service delivery with very low risk.
Not specified
Not specified
None
22
itself does not reflect the true image of sustainable basic water services (DWA,
2010a). Despite high infrastructure coverage, it was indicated that many rural
households have difficulty in accessing sufficient volumes of potable water in areas
that are within the “served” communities due to poor maintenance and increased
population leading to high water demand, leaving the communities without water for
days (Hay et al., 2012). The incapacity of WSA’s in managing the maintenance of
water infrastructure remains a big challenge in SA (Hosking & Jacoby, 2013). The
current water supply unrests, due to water scarcity, are a way of expressing
dissatisfaction by the communities who do not have access to sustainable safe water
supply (Tapela, 2012).
The White Paper on Water Supply and Sanitation Policy in SA states that if water is
not available, WSA’s should provide the community with an alternative source within
24 hours (DWA, 1994). Often an alternative source is not provided, leaving the
community without water for months and thus rendering the infrastructure provided
inefficient (Hunter, Pond, Jagals & Cameron, 2009). The situation often causes
desperation that leads the communities to resort to unsafe water sources for the
sake of survival (Tapela, 2012). Therefore, communities will need household water
safety strategies to protect themselves from risks regardless of the manner in which
they access their water.
The distance where water is accessed determines the volume of water the
household can use, the risks to the people living in the household as the water
quantity could adversely affect its use and the maintenance of good hygiene
practices in households (Pickering & Davis, 2012).
23
2.2.2 Availability
The concept water availability refers to any system or source that is capable of
producing a certain volume of safe water which could be accessed by the community
at any time. Various standards were set to make the concept measurable by the
users. The concept was also set internationally and most countries follow these
indicators as a way of measuring its basic water availability, as indicated in Table 2.1
(Howard & Bartram, 2003). SA has set its own standard based on the acceptable
volume of water suitable for its communities, as well as the time spent to access
such volumes, which together have direct impact on the management of water at
home. The water quantity accessed is one of the fundamental criteria which
characterise the state of water service received by the community. Where the
infrastructure is accessible but water is not available, confusion is caused within the
community. An alternative way of frequently monitoring the compliance of the
service rendered is for proper intervention and prevention of risks to the community
due to the high number of people without water access.
Availability of safe water at home could play an important role in decreasing the
household risks (Mellor et al., 2012) as outlined in Table 2.1. In addition, Jagals
(2006) describes the concept, water availability, as enough volume of water to the
user that is potable, equitable and consistently available for the purpose of drinking
and all domestic activities in a household; while the Sphere project (2004) defines
the availability of water in terms of emergency as water that does not take more than
three minutes to fill a volume of 20ℓ. It is again elaborated that water should be
consistently available on a regular basis and 15ℓ of water should be available per
24
person per day and queuing time should not exceed more than 15 minutes. The
understanding of this concept by Howard and Bartram (2003) further indicated that a
minimum of 7.5ℓ of water per person per day is enough for any person in any
condition, hence this figure needs further investigation to align it with specific risk
level. The consistency on the availability of water is shown as the major variable in
this concept which determines the level of water service within the community.
However, this concept on availability needs further analysis in terms of the
community water service limitation and access to this valuable resource. However,
the policy governing the access of such volume of water and the time spent as well
as its impact to household water availability might need further analysis in terms of
the concept.
The White Paper on water and sanitation policy describes water availability as the
continuous supply of water on a regular basis without cut-off (DWA, 1994). The
policy further explains that availability of water should not be interrupted for more
than 48 consecutive hours and the local authority should take reasonable steps in
providing the community with alternative sources within 24 hrs. In the case where
water is not available at all, at least 10ℓ of water per person per day should be made
available (DWA, 2010c). The 10ℓ water could mean acceptable water volume that
could be enough for any condition, as compared to 7.5ℓ of water limit outlined by
Howard and Bartram (2003). However, most WSA’s in SA do not conform to these
indicators.
The community unrests around SA are typically influenced by shortage of water and
lack of communication on basic water service delivery (Hay et al., 2012; Tapela,
25
2012). Poor management and lack of capacity in WSA’s to ensure continuous water
availability are the main challenges (Hosking & Jacoby, 2013). International and SA
water indicators differ, as SA do not have a queuing rate which could have a major
impact on the acceptable time spent for water collection. There are limited studies
for analysis of 200m radius, time spent at the collection point plus time spent to
arrive at home. Where accessibility and quantity of water cannot be measured, it
could be difficult to manage water service delivery.
The above standard is still a dream and a challenge to most rural areas of SA, as
provision of safe water is still not up to the required standard. The recent study
conducted by Majuru, Jagals and Hunter (2012) in SA, indicated that most
households do not have access to acceptable volumes of water due to water cut-offs
for up to 3 months. It further indicated that the farthest one-way distance travelled to
a tap was 268m, while alternative sources increased the distance to 600m. Most of
these households members resort to unprotected water sources (Majuru, Jagals &
Hunter, 2012), while others buy from private supply (Evans et al., 2013)
subsequently leading to increased health risks and poverty in communities.
The availability of water in communities is in conjunction with the provision of
infrastructure and the volume of water needed for domestic purposes, which is also
dependent on the distance travelled, reliability of water source as well as total time
spent on collection to reach the household (WHO/UNICEF, 2008). Most
communities consider it vitally important to have continuous water services on a daily
basis (Bradley & Bartram, 2013). The study conducted by Hope (2006) indicated
that most households are not satisfied by collecting water outside their compound as
26
it is difficult to acquire the amount required. The outcomes of the study recommend
changes in policy in terms of household water supply. It is therefore important for
this study to come up with the theoretical estimate of water quantity available at the
tap, which could determine the volume of water accessed by each person in the
household based on the indicators provided versus the number of taps available.
This will ensure measurement of the risks or performance by the municipalities in
rendering safe water to the public. This estimate measurement will only apply in
villages where taps are provided outside the household and population is known.
The quality of water is also very much important when this method is used. When
access to sustainable water service is not attainable, continuous communication on
health risks and water treatment to ensure water safety use by the community is
essential.
2.2.3 Potability
Potability is described as water which is drinkable and suitable for domestic use such
as drinking, cooking and personal hygiene. To reduce health risks, the water should
be accessed from improved water sources which are considered safer than
unimproved sources. However, getting water from improved sources does not
guarantee its safety. WHO/UNICEF (2012) describe improved drinking water as the
use of piped water connected in household yards, public taps, tube wells or
boreholes, protected springs, protected dug wells and rain water collection, whereas
unimproved water sources include unprotected dug wells, unprotected springs,
tanker trucks, surface water and bottled water. Unimproved sources are those
sources which could be easily contaminated and cause health risks to the
27
consumers. Water is considered safe if it is free from pathogenic microorganisms
and high chemical content beyond acceptable limits, as outlined in Table 2.2.
Availability and accessibility play an important role in household water service
delivery but failing to maintain its quality could be fatal to the community served. It is
a requirement of every local authority to provide its community with water which is
potable and safe for human consumption. Any absence of water availability or long
distances travelled to collect water could become a challenge to maintaining its
microbiological quality (Hope, 2006), which could lead to unsafe sources used
(Nnaji, Eluwa & Nwoji, 2013). This situation could require the community to acquire
skills to manage and treat its water used for various household activities. The more
water is closer, available and accessible to the point of use, the less the risks (Prüss-
Üstün et al., 2008; Wang & Hunter, 2010). However, availability and accessibility
should be supported by ensuring that potable water is always provided. Poor access
to potable water that is safe could put the communities at risk as they usually find an
alternative way of accessing water with limited consideration of its safety.
Benchmarks for both International and SA are available to measure the
microbiological risks in water quality as outlined in Table 2.2.
WHO and South African National Standard (SANS) 241 (2011) further described
safe drinking water as having less than 1 count of Escherichia. coli (E.coli) per
100mℓ (South African Bureau of Standard, 2011; WHO, 2008). E. coli is one of the
indicators used to determine water quality and the presence of faecal pollution from
warm-blooded animals (WHO, 2008). However it is not usually feasible to comply
with the standard, especially in poor and rural areas. Swart (2014) indicated that
28
95% compliance of tests conducted is acceptable based on the Quantitative
Microbial Risk Assessment (QMRA) of the characterised population, as outlined in
Table 2.3. Enterococcus is also one of the microbial indicators regarded as the better
marker than E. coli in certain conditions (Risebro et al., 2012).
Table 2. 2: Water quality indicators based on both International (WHO, 2008)
and DWA, 1998; South African Bureau of Standard, 2011)
SA water quality standard International Standard
Determinant Units no
risk
Low
risk
Medium High
risk
Very
high
risk
no
risk
Low risk Medium High
risk
Very
high
risk
pH at
25°C
5-6 6-9 9-9.5 9,5-10 >10 6.5 >6.5-8.5 9.-9.5 No
standard
No
standard
Electrical
conductivity
mS/m
at
25°C
<70 70-
150
150-370 370-
520
>520 <47 48-93 94-140 141-187 >187
Turbidity NTU <0.1 0.1-1 1-20 20-50 >50 <1 1-5 No
standard
No
standard
No
standard
Total
coliform
CFU/
100m
ℓ
<1 1-10 >10-100 >100-
1000
>100
0
<1 1-10 11-100 101-
1000
>1000
E-coli CFU/
100m
ℓ
<1 1 >1-10 11-100 >100 <1 1-10 11-100
101-
1000
>1000
Enterococci CFU/
100m
ℓ
< 1 >1-10 11-100 >100 <1 1-10 11-100
101-
1000
>1000
29
Its main difference with E. coli is that some of the species survive longer in water and
found in the environment and in faecal matter (Atusinguza & Egbuna, 2012; WHO,
2008). It is recommended as the best parameter to measure health risks (Risebro et
al., 2012). Both international and SA standards indicated the microbial water quality
risks of these bacteria as outlined in Table 2.2.
The presence of indicator organisms in water could indicate the possibility of
waterborne diseases such as cholera, dysentery, Shigellosis, Typhoid and many
more (Conant & Fadem, 2008). Most of these diseases, such as cholera, is known
to cause outbreaks in many developing countries (Mukandavire et al., 2011).
Diarrhoea is one of the biggest killer diseases in children in developing countries
including SA (WHO, 2007) and has been associated with inadequate sanitation and
poor access to safe water (WHO, UNICEF, 2010). It is therefore important to drink
water which is safe to safeguard the lives of the public.
In rural households, factors which contribute to household water contaminations are
influenced by poor environmental conditions including poor disposal of waste,
unsanitary and inadequate protected containers, contaminated hands and dippers
that disperse water, inadequate clean water vessels and containers and poor
protection against contamination due to household water behavioural practices
(Sobsey, 2002; Tambekar et al., 2008). Such poor practices may contribute to poor
water quality in the domestic setting. Access to safe water volume of 50ℓ /c/d or
more per could reduce significance risk level (Moriarty et al., 2010).
30
The South African government regards water supply as an essential service and
regards it as a constitutional right for its citizens to have access to clean and
wholesome water (SA Constitution Act, 1996). The Government has placed water
supply as a priority for its citizens and strives to ensure regular safe water supply for
its people. This is supported by the DWA which spends millions of rand each year on
infrastructure to supply drinking water in various communities (DWA, 2010a).
Unfortunately, scarcity of water and inefficient personnel combined with poor
management or incapacity of WSA’s means the system is unreliable (Tapela, 2012).
Communities are usually left without potable drinking water for long periods and as a
result, communities look for alternative sources which are often not safe for human
consumption (Peter, 2010). It was also highlighted as a gap that needs to be looked
at when monitoring of water services is done globally (United Nations, 2013b). This
renders the water service provided by the municipalities ineffective (Hunter, Zmirou-
Navier & Hartemann, 2009). Unfortunately, these conditions make poor households
resort to unprotected sources and become more vulnerable to risks.
Provision of potable water by the WSA’s does not guarantee the safety of the water
when it reaches the households (Künzle & Morgenroth, 2011) and this depends on
the quality of water accessed by the community at the POU (Mokoena & Jagals,
2009). Thus, applications of household water safety precautions are essential to
prevent health risks. The above standard cannot usually be attained in developing
countries such as SA. Supplying water which has low or medium risk is attainable
but should be based on the outcomes of QMRA. The use of thermotolerant
coliforms, E. coli and intestinal enterococci are useful predictors of risk as they
indicate faecal pollution (Savichtcheva &Okabe, 2006; WHO, 2011). However
31
pathogens such as Cryptosporidium and viruses may still be present in water even in
the absence of faecal indicator bacteria. It is therefore important to evaluate the
household water safety and treatment intervention based on the targeted
microorganism against the anticipated outcomes.
2.3 BENEFITS AND LIMITATIONS OF USING INDICATOR BACTERIA FOR
WATER QUALITY ANALYSIS
The use of indicator bacteria, such as total coliforms, E. coli and enterococci, was
historically used to monitor water safety and to predict the presence of bacterial, viral
and protozoan pathogens (Savichtcheva &Okabe, 2006). Currently, thermotolerant
E. coli are still used as a faecal indicator in drinking water in most developing
countries despite their perceived weaknesses of not surviving for a long period
compared to other faecal indicators (Simiyu, Ngetich & Esipila, 2009). It is important
to judge faecal indicator for water safety based on the following quoted from
Medema et al. 2003:
“The indicator should be absent in unpolluted water and present when the source
of pathogenic microorganisms of concern is present;
The indicator should not multiply in the environment;
The indicator should be present in greater numbers than the pathogenic micro-
organisms;
The indicator should respond to natural environmental conditions and water
treatment processes in a manner similar to the pathogens of concern;
32
The indicator should be easy to isolate, identify and enumerate;
The test should be inexpensive thereby permitting numerous samples to be taken
and
The indicator should not be a pathogenic microorganism (to minimise the health
risk to analysts)”.
Pathogens such as bacteria (e.g. Campylobacter jejuni), viruses (e.g. Rotavirus) and
protozoan parasites (e.g. Cryptosporidium) are considered to be of high public health
concern based on their association with outbreaks of waterborne disease (WHO,
2011). Many pathogens and Cryptosporidium oocysts and Giardia cyst in particular
can survive chlorination and remain a risk even when indicator bacteria are absent
(Betancourt & Rose, 2004). Although newer molecular methods are permitting the
rapid detection of a wide range of pathogens in water, these methods are much
more expensive and their widespread use for routine water monitoring is still a long
way off.
2.4 HOUSEHOLD WATER SAFETY AND MANAGEMENT
The Water Safety Plan (WSP) model is an approach that is adopted by various
countries to mitigate the risks in water, by implementing best practices to ensure
continuous supply of safe water from the source to the consumer (Bartram, 2009;
Hunter, MacDonald & Carter, 2010). Almost every region in the world today,
including SA, have implemented the WSP. The main reason being to “manage and
control the activities within the water chain system; implement and identify the
opportunities for low cost improvements on operation practices that enhance water
33
safety; prevent water deterioration during distribution, handling and storage in
households; improve the stakeholder communications and collaboration within water
sector and give understanding to water users on complete water chain and its
vulnerability” (Gelting, 2009). However, the monitoring of risks at household level in
poor and rural households is limited, although sustainable water service delivery and
provision of water that is safe could not be guaranteed in most developing countries
(Clasen, 2010; Evans et al., 2013).
The Blue Drop certification strategy, introduced through incentive-based regulation
on 11th September 2008, is one of the drinking water strategies used in SA to
monitor the compliance of drinking water systems to its WSA’s (DWA, 2009b). The
purpose of this regulation is to manage risks by providing the quality of water from
point of generation to the tap water on the street, in household yards with or without
a meter. The regulation indicates government commitment to providing safe potable
water to its communities (DWA, 2010c). It is unlikely that the focus dwells much on
the tap and not extended to the point of use.
The mitigation of risks given to these communities is not consistent and dwells on
the water source to the tap on the street or yard, hence it is well proven that there is
a challenge of water quality access and deterioration in the household at the point of
use which renders the treatment at the source less efficient (Taulo et al., 2008). This
may indicate the need for managing potable water from the source to household
level and at the POU to improve quality of life. Due to water scarcity in some rural
and informal settlements of SA, there is a need for the country to shift its focus from
34
the street tap to the household by encouraging good water practices at domestic
level.
SANS 241-2011 and quality of domestic water supplies are used as recommended
standards for water quality (DWA, 1998; South African Bureau of Standard, 2011).
The system assessment in the WSP is to identify events that have the ability to make
potable water harmful and no longer fit for human consumption within the water
supply chain system comparing them with the established standard. If hazards are
identified, it informs stakeholders that the water is not potable and will become more
dangerous than its original state (WHO, 2011). The assessment of physical
parameters is also important in assuring provision of safe water to the communities.
Therefore, both microbiological and physical water quality are essential in Blue Drop
assessment to ensure safe water is provided timeously.
2.5 NON-MICROBIAL PARAMETERS
The physical parameters such as pH, turbidity and electrical conductivity play a
major role in determining the quality of water. The results of the physical parameters
determine the effectiveness and water treatment method required at household level
and appropriate control measures that will render the water safe (WHO, 2011).
35
2.5.1 pH
pH is described as the degree of acidity or alkalinity in water which indicates whether
it is sour or soapy when tested (DWA, 2001). The acceptable pH level in drinking
water should be within 6-9 range (South African Bureau of Standard, 2011).
Unpolluted groundwater has a pH ranging from 6.5 to 8.5 (DWA, 2001). High pH
causes a bitter taste and water pipes and water appliances are encrusted with
deposits that eventually cause damage, while low pH causes corrosion to metals
(United States Geology Survey [USGS], 2012). The level of pH could also determine
the survival of microorganism in drinking water. The effects of pH to humans are
that it causes irritation to eyes, mucous membrane and skin irritations (WHO, 2008).
2.5.2 Turbidity
Turbidity is the physical parameter used to assess the cleanliness and hygiene
status of water (USGS, 2012). It is the parameter used to measure the cloudiness or
muddiness in water (DWA, 2001). It can promote the regrowth of pathogens in water
and inhibit the effectiveness of disinfection or treatment in water (Environmental
Protection Agency [EPA], 2012). It is measured by a Nephelometric turbidity unit
(NTU) and can cause high costs in water treatment (Minnesota Pollution Control
Agency, 2008). The turbidity unit should be <1, while a value of >5 should bring the
alert level as it can result in the risk of infection (DWA, 2001; South African Bureau of
Standard, 2011).
36
2.5.3 Electrical conductivity
Conductivity is the measurement in which water conducts electricity. Rain water is
usually low and indicates the total dissolved salts in water. In arid land, groundwater
is usually indicated by high conductivity (DWA, 1998). The acceptable electrical
conductivity is <70 mS/m, while a value of 370 mS/m and higher is considered to
cause potential risk of infection (DWA, 2001; South African Bureau of Standard,
2011). The higher electrical conductivity may be a risk to patients with high blood
pressure or renal disease. Marked changes in conductivity could indicate the level of
contamination (USGS, 2012).
2.6 QUANTITATIVE MICROBIAL RISK ASSESSMENT OF DRINKING WATER
QUALITY IN HOUSEHOLDS
Soller (2006) defines QMRA as the assessment on the probability of individuals to
become sick after consumption of certain amounts or concentrations of pathogens.
Using QMRA as recommended by WHO (2011) could assist in determining the
pathogens pathways, microorganism of concern and amount of pathogens that can
cause risk of infection, such as acute gastroenteritis, as well as intervention
strategies to be used. The possibility of individual risk of infection differs from one
individual to the other, based on the type of water source used, age, genetic factors,
host susceptibility characteristics, concurrent infections, previous exposure history,
volume of water consumption and population characteristics and immunity (WHO,
1999). Consequently, such infection is characterised by profound diarrhoea, with or
37
without blood, for more than three days. Some infections may lead to disease
outbreaks such as cholera, so QMRA can assist in preventing risks if applied well.
Haas et al. (1999) suggested four steps to be followed when QMRA is implemented,
which include hazard identification, exposure assessment, dose–response analysis
and risk characterisation. The QMRA conducted by Hunter et al. (2011) on the risk
of Giardia and Cryptosporidium in very small private supplies, was found to be above
the tolerable risk but the rate of infection was low which could be attributed to the
development of immunity towards the water source used. However the studies
made by Steyn, Jagals and Genthe (2004) indicated the risks of E. coli in both
untreated and treated water used for drinking, but discouraged the use of E. coli as
the only parameter as it cannot reliably predict the rate of infection that the health
personnel could expect. The researchers further suggest that to verify cause of
infection by E. coli, full epidemiological investigation will have to be made.
The determination of risks in an area is usually informed by the accessibility,
availability and level of water quality required as per QMRA. When water is not
accessible or available, it will be difficult to implement the WSP. The situation could
be more of a challenge when the households have to find drinking water somewhere
else, or in unprotected sources other than the one obtained from protected sources
provided by the WSA. The location where water used for drinking is located plays a
crucial role in determining its safety. When communities access water from different
sources, it becomes complicated to determine the way in which risks could be
identified and WSP approach could change, following the situation in which
38
communities find themselves. Hence, the use of QMRA could assist in determining
the treatment method that can be used based on health based target standard.
WHO (2011) suggests that top tier technology can remove pathogens that will limit
disease burden of 10-6 Disability-Adjusted Life Year (DALY), hence the second tier of
protection defines pathogen removals of health based target of 10-4 DALY per
person per year. It could be difficult or not feasible to have technology that is
excellent to limit the disease in rural areas because of the poor infrastructure
available.
Most rural WSA’s will strive to supply water which is acceptable or good to health
targets. The suggestion made by Swart (2014) indicated that at least there should
be 95% compliance in water samples in populations of up to 100 000. The use of the
QMRA model could assist in regulating water utilities, which will determine the risk of
exposure to unsafe water, to employ and select the correct treatment options
required. The availability of policies and strategic documents could assist in
assessing and measuring basic water service delivery for effective compliance to the
standard set by Authorities.
2.7 POLICIES AND DOCUMENTS REGULATING BASIC WATER SERVICE
DELIVERY IN SOUTH AFRICA
Policy is described as one of the deliberate tools aiming to address various issues or
challenges that need an action within an institution or sector so that proper resources
can be adequately allocated (De Coning & Sherwill, 2004). The United Nations (UN)
requires every country to develop policy or strategy that ensures the provision of
39
safe water that is accessible, available, acceptable and potable to its people (United
Nations, 2013b). Where safe water cannot be provided sustainably, precautionary
measures need to be taken.
Access to safe water is a fundamental human right and paying attention to these
rights to ensure the beneficiaries are part of the issues that affect them through
access to information is essential to understand and act in a rightful way (Sphere
Project, 2004). To ensure the right to water is met, SA has developed a policy which
provides free basic water to the poor (DWA, 2002). To scale up access to safe
water, a household water safety policy was recommended and a target of 30
countries with this policy is expected to be reached by 2015 (WHO/UNICEF, 2012).
It was emphasised that the development of the policy should not hinder the main
objective of providing continuous water service to the community, but should be
taken as a way of ensuring sustainable safe water use.
Most of these countries emphasise the provision of safe water as a critical strategy in
eradicating poverty and improving the status of health. However most of the policies
in these countries recommended that, every water supply project or programme
should follow reasonable measures that will aid in preventing risks in water (United
Nations, 2013a; Wate, 2012). The slow pace in the implementation of such policies
could pose more risks to the community.
The South African Constitution Act (108 of 1996) emphasises the rights of every
citizen in SA to have access to basic potable water supply. The WSA’s should
ensure that these rights are met by providing water to its communities as outlined by
40
Water Service Act (108 of 1997). The implementation of these legislations is
outlined within the framework of SA Water Supply and Sanitation Policy White Paper
of 1994 (DWA, 1994). The policy demonstrates the importance of safe water access
and availability at all times. In terms of how water services should be delivered, SA
has developed strategies, policies and legislations addressing water service delivery
as shown in Table 2.3.
Table 2.3 indicates some of the legislations and strategic documents in SA that
address access to water service. The SA local government Municipal Structures Act
(1998) established WSA’S to be responsible for water issues in the municipality,
while the SA Water Service Act (107 of 1998) outlines the responsibility of
municipalities in ensuring that water service is given without failure. Unfortunately
the basic water indicators are not taken into consideration when such services are
rendered.
Consequently, the water service indicators reflected in Table 2.1 highlight the
quantity of water required to meet health requirements. Furthermore, it indicates
water quantity and benchmarks it with the level of risk that could have impact on
public health. When communities do not have enough water, they often use unsafe
water sources or compromise hygiene practices in the households which affect the
level of water quality as shown in Table 2.2. This situation can be corrected through
education, which could be attained if mentioned in water and sanitation policy.
This study argues that the recommended water service level indicators do not cover
all the factors needed to make measurements of the effectiveness of the service. It
41
is evident that the WSA’s in rural areas could not measure its services using such
indicators. However, it is emphasised that only good quality water should be used.
The study found there is a need for WSA’s to measure its service level especially in
rural areas where taps are provided without meters and the sustainability of water
service is a challenge. The study recommends the methodology, outlined in Section
2.5, of estimating measurement for basic water service delivery using conceptual
framework indicators.
Prior to 1994 there was no measurable indicator that governed the level of basic
water service delivery in SA. The right of everyone to have access to safe water was
first defined by the African National Congress (ANC) in its Reconstruction and
Development Programme (RDP) of 1994 (African National Congress, 1994). This
was followed by the White Paper policy developed in November 1994 (DWA, 1994).
It is from this paper where indicators for basic water service delivery were defined in
terms of accessibility availability and potability. In 1996, a Constitution was
developed which emphasised the right to clean water services to all a indicated in
Table 2.3 (SA Constitution Act, 1996). More policies and legislative pieces were
developed aimed at the improvement of basic water and sanitation services.
Between 1994 and 2004, 13.4 million people were provided with basic water supply
through various government structures, while a further 10 million were provided
through DWA. The current challenge is that not all taps provided, especially in rural
areas, could produce enough volume of water for each person (DWA, 2010c).
42
Table 2.3: Strategic documents and legislations on basic water service
delivery in South Africa
To determine the WSA’s performance on water services, the development of an
estimate measurement of household water availability per capita per day formula in
terms of indicators outlined in Water Supply and Sanitation Policy and DWA (2010b)
was initiated. Indicators were further broken down according to scores that quantify
level of basic water service delivery assessment by WSA’s as mentioned in Section
2.8, 2.9 and 2.10.
Policy/legislation Main Theme Key issues addressed Reference
Drinking water regulation strategy
Provision of safe water
Monitor, manage, communicate on water service delivery and regulate water quality.
Department of Water Affairs, 2005
Free basic water implementation strategy
Free basic water service regulation
Free basic water provided to the poor Department of Water Affairs., 2002
Municipal Structures Act (117 of 1998)
Powers and functions of District Municipalities
Water, sanitation and municipal functions aiming at prevention of communicable diseases.
Municipal Structures Act, 1998
Water supply and Sanitation Policy (White paper)
Provision of safe water service to the community
Access, affordable, availability and provision of potable water.
Department of Water Affairs, 1994
National Water Act (36 of 1998)
Water Regulation Water regulation in relation to protection, use, management, conservation and control.
National Water Act., 1998
National Water Services Regulation Strategy
Regulating national water services
Protecting the interest of the consumer and public through effective regulation of water supply and sanitation services.
Department of Water Affairs, 2010
SA Constitution Act (108 of 1996)
Bill of rights Right to safe water SA Constitution Act 108, 1996
SA drinking water quality management performance “Blue Drop”.
Sustainable provision of safe water by WSA’s.
WSA adhere to safe water standard SANS 241 to ensure provision of safe water to the community.
Department of Water Affairs, 2009
Water Service Act (108 of 1997)
Provision of water service by WSA’s
Water service in relation to drinking water provided by the municipalities.
SA Water Service Act 108, 1997
43
The monitoring of water services done by WHO/UNICEF (2012a) is measured
through the population census based on the infrastructure provided; counting figures
of improved and non-improved facilities used (WHO/UNICEF, 2012b). The
challenge with this method is that it does not consider the sustainability of basic
water supply and water quality issues. The other difference is that their survey is
done on a larger scale rather than in a localised area. Though it is known that the
sustainability of water services is crucial when such surveys are done, there is no
accurate information given on reliability of the services rendered.
Mansour (2011) developed a way of measuring water accessibility and availability by
using Geographical Information System (GIS). The uniqueness of this method is
that it is one of the methods which could be used in a small-localised area, but it
needed technical skill to apply it. Water Aid has developed its own methodology,
which is an accurate way of measuring water accessibility using Global Positioning
System (GPS) to count the functionality and non-functionality of systems used within
the area of service (Water Aid, 2009). The disadvantage of this method is that it
takes a long time and needs hefty financial resources to be executed.
The methodology proposed is a rapid estimation of measuring quantity of water that
is available for each person against the number of systems available, as well as its
functionality. Taps used for activities other than household should be excluded. The
advantage of using this method is that it does not need a specialised skill, someone
who can do simple counting could easily use it as long as correct figures and records
are available. It is fast and could give a clear indication on the actual volume of
water accessed by community at that time. Its limitation is that it is not accurate,
44
although it can give an idea on the kind of service people receive. Hence it can also
alert the WSA’s on the risks that could be faced by the community as outlined on the
service delivery ladder framework (Moriarty et al., 2010). The main reason for using
this methodology is to measure systems effectiveness in delivering the quantity of
water required for each person in the household. This method is similar to the one
on the equitable access score-card as outlined by the UN (2013b), as it requires self-
assessment using water service indicators . The only difference is that it uses a
combination of scores with equations as outlined in the proceeding section.
2.8 AVAILABILITY ASSESSMENT
The methodology for rapid estimate measurement for availability, accessibility and
potability of water service delivery in households found in a small localised area is
explained as follows:
To determine the volume of water that could be accessed by each person in the
household the following formula was developed, as outlined in equation 2.1,
following the water service indicators measurements indicated in the 1994 White
Paper policy on water and sanitation policy (DWA, 1994).
Availability =
Volh
×h
day× No. functional taps
Population size
Equation 2. 1: Formula determining volume of water accessed by each person in household.
Total number of functional taps (taps with running water) versus non-functional ones.
Total number of population (count total number of households and multiply by
average number of people as per census results).
45
Total number of hours per day when water is available (count number of hours
when water is available).
Volume of water that is accessed within an hour (measure the tap up and low
slope and the one in the middle)o. Open the tap to its fullest, count litres of
water accessed within a minute, multiply that by 60 minutes then you will get
volume of water per hour. Add each volume of water per hour and divide it by 3
then you can get an average volume per hour of the entire village).
Equation 2.1 determines the average litres of water that are accessed by each
person in a household. The results are measured against the risks as outlined in
Table 2.4 and by Howard and Bartram (2003) as outlined in Table 2.1. Intervention
measures could be employed based on the outcomes. The estimate availability
methodology suggests that having water each day at different intervals or provided
at a low pressure does not mean that the WSA’s are conforming to the standard.
This is especially true in areas where water cannot be provided continuously but
scheduled intervals are used. The availability of water and its risks were calculated
in terms of the White Paper on Water Supply and Sanitation Policy (DWA, 1994).
Table 2. 4: Availability scores (Based on measurement shown in DWA, 1994)
Risk level No of days’ water unavailable.
No threat Water available 24 hours.
Tolerable Water not available for various days within a year of no more than 7 days-not in
sequence.
Peripheral Water not available for a week.
Not tolerable Water not available for more than a week in sequence.
46
The above scores, in Table 2.4, were determined in terms of water availability.
Where water is not available for the whole week the score is considered medium but
could be a threat to the immune compromised individuals; if water is not available for
more than a week, WSA should intervene by delivering water education or safe
water to the communities to prevent health risks.
Studies done by Majuru et al. (2010) showed the increase in the number of acute
diarrhoea is linked to major disturbances in water service; while Howard & Bartram
(2003) link the volume of water accessed with the level of service. The outcomes of
water quantity outlined in water availability formula could be benchmarked with the
level of service as outlined in Table 2.1, based on the large spectrum of the
measurement indicated by Howard and Bartram, (2003); DWA (2004) and DWA,
(2010).
2.9 ACCESSIBILITY ASSESSMENT
To determine water accessibility in terms of distance travelled, the following
relationship in the form of equation was also developed based on Water Supply and
Sanitation Policy White Paper (DWA, 2004):
𝑨𝒄𝒄𝒆𝒔𝒔𝒊𝒃𝒊𝒍𝒊𝒕𝒚 = 𝑷𝒓𝒐𝒑𝒐𝒓𝒕𝒊𝒐𝒏 𝒐𝒇 𝒑𝒐𝒑𝒖𝒍𝒂𝒕𝒊𝒐𝒏 𝒕𝒓𝒂𝒗𝒆𝒍𝒍𝒊𝒏𝒈 ≤
𝟐𝟎𝟎𝒎 𝒕𝒐 𝒄𝒐𝒍𝒍𝒆𝒄𝒕 𝒘𝒂𝒕𝒆𝒓 ∶ 𝑷𝒓𝒐𝒑𝒐𝒓𝒕𝒊𝒐𝒏 𝒐𝒇 𝒑𝒐𝒑𝒖𝒍𝒂𝒕𝒊𝒐𝒏 𝒕𝒓𝒂𝒗𝒆𝒍𝒍𝒊𝒏𝒈 > 𝟐𝟎𝟎m
(𝑵 ≤ 𝟐𝟎𝟎𝒎: 𝑵 > 200𝒎)
47
Equation 2. 2: Relationship between the proportions of population travelling a
distance of <or >200m to collect water [Based on measurement indicated in
1994 White Paper on Water Supply and Sanitation Policy (DWA1994)]
The number of household without water access within 200m should be recorded in
order to determine the number of people who are at risk of utilising other sources of
water when equation 2.2 is used. According to the study conducted in few villages in
Limpopo Province, it requires up to 268m for household members to access the
nearest tap, which measures only the one-way trip in areas where basic water
services are provided (Majuru, Jagals & Hunter, 2012).
The time a person needs to travel to the tap is not determined. If we follow the
distance of 1000m roundup trip travelled in 30 minutes as determined internationally,
South Africans will need an average of 6 minutes to travel to the water point within
200m. The distance will not always be feasible when looking at the elements which
determine the route to the water point considering mountainous, round-up route,
waiting periods and environmental conditions could increase time to reach the water
collection point.
The distance of 200m needs to be reviewed, as it is the one-way distance that does
not consider the type of route used, its safety, and distance travelled to come back
home, mountainous or easy access route, as well as total time used as outlined by
Dar and Khan (2011). To emphasise this, Crow et al. (2013) indicate there is a
significant difference between the distances travelled to the source and waiting
48
period, therefore both times need to be considered when the average water
collection time is determined.
The standard distance outlined in SA is quite reasonable compared to the
international standard, although not realistic as the total time used for water fetching
is not indicated. The formula on accessibility gives an idea on the proportion of
households who could walk greater than 200m and were tempted to use the
unimproved sources that are convenient from where they stay, as indicated in Table
2.5.
Table 2.5 indicated the water distances that the WSA’s could determine their level of
service delivery distance of 10m to 200m as being tolerable and peripheral, whilst
distances of more than 200m were considered intolerable, making the communities
consider using unsafe sources for their convenience. Where distances of greater
than 200m are recorded, the WSA’s should intervene by ensuring that safe water is
brought nearer, or invest in education on safe water treatment and storage.
49
Table 2. 5: Accessibility score (Based on measurement indicated by DWA, 1994)
.
Studies confirmed that communities travel long distances to fetch drinking water but
use any water in proximity to them for other domestic chores (Peter, 2010). This is
because when water is not available, the distance to access drinking water
increased making it difficult for them to access enough water to use (Taulo et al.,
2008).
2.10 POTABILITY ASSESSMENT
The potability of water is measured according to the following scores of microbial
risks that need to be benchmarked, with the risk outlined on Table 2.6, in terms of
microbial water quality risks. The WHO (2008) measured the risk in relation to 1 to 5
score determining various risks, while the DWA (2001) and South African Bureau of
Standards (2011) determined the risk in terms of score 1 to 4. Table 2.6 indicated
Risk level Distance
travelled to the
tap
Position where tap is found and time
interval
No threat 0-10m Tap available in or attached to the house and
access within 3 minutes.
Tolerable >10-50m Tap available within the yard access within 6
minutes.
Peripheral >50m-200m Tap available on the street access within 15
minutes.
Not
tolerable
>200m Tap on the street; unsafe sources could be
used where access time is more than 20
minutes.
50
the microbial risk determined in scores 0 to 10 using the risk level of good, tolerable,
peripheral and not tolerable, depending on the number of E. coli or enterococci
detected per 100mℓ of samples. The probability of risks in terms of microbial water
quality on this measurement is rated in terms of small localised areas, based on dry
and wet seasons due to variation of microbial activities that could occur. Previous
microbiological water quality outcomes detected within a year could be used to
measure the probability of risks. Where no record is available, sets of samples
should be taken to measure the quality of water used.
Table 2. 6: Potability score (Adapted from WHO/UNICEF, 2012)
The WHO/UNICEF’s (2012c) “Toolkit for monitoring and evaluating household water
treatment and safe storage programmes” was used to determine the score and the
intervention required, where 7 to 10 score is detected, urgent intervention measures
will be required, while 4 to 6 requires high and 1 to 3 is considered a low risk where
low or no action is needed depending on the health outcomes and informing the
Score Risk
level
Microbial risk
0 No threat No E. coli or Enterococci detected in previous two seasonal
samples.
1-3 Tolerable E. coli or Enterococci detected in no more than 1 out of
previous 2 seasonal samples taken and using counts 1 /
100ml CFU.
4-6 Peripheral E. coli or Enterococci detected in more than 1 out of previous
2 seasonal samples taken and counts 10 / 100ml CFU.
7-10 Not
tolerable
E. coli or Enterococci detected in more than 1 out of previous
2 seasonal samples taken and counts >10 / 100ml CFU.
51
community on how to manage their water to make it safe for consumption
(WHO/UNICEF, 2012).
2.11 GENDER AND HOUSEHOLD WATER SAFETY MANAGEMENT
By virtue of nature and culture, society’s origin in distinguishing male and female
roles and responsibilities and positions differ from one culture to the other. In most
African cultures, the role and responsibilities for household chores and educating
children are for women, whilst men are supposed to support in terms of financial
resources. In most developing countries, women are responsible for primary use of
water, management, health promotion, sanitation and hygiene of the household
(United Nations, 2005b). In most circumstances, women are affected by inadequate
water provision than men (United Nations-habitat, 2006). Women find themselves in
a situation where they have to travel long distances and spend lots of hours
collecting water. The biggest challenge is that in most developing countries the
water is usually unsafe and vulnerable for recontamination (WHO, 2012).
An agreement was made in Johannesburg on the implementation plan made during
the World Summit on Sustainable Development, in 2002, by various countries
(Paragraph 25) to involve women in building water and sanitation infrastructure.
Women’s presence in water and sanitation projects has yielded benefits. The World
Bank (2007) indicated the need for equal representation of men and women in water
and sanitation committees.
52
The United Nations lobbied for the inclusion of women operators at municipal level.
Development of policy relating to household water storage and treatment in PRH is
recommended as the approach that can be used to speed up health gains to enable
the developing countries to meet the MDG by 2015 (United Nations, 2005). The use
of a WSP approach for small water system users could empower the communities to
have control over their potable water, to effectively manage until the point of use.
This could lead them to prioritise safe water and invest in their families’ health hence,
improving the public health gains.
2.12 SUMMARY
The review highlighted the need for provision of a basic water service which is
accessible, available, potable, affordable and sustainable. The importance of
measuring basic water service delivery through indicators to benchmark WSA’s
performance was shown. Where one concept is not attained it could escalate the
risks faced by the community in terms of their welfare. More emphasis was based
on the need for WSA’s to set indicators that go with the concepts.
An analysis of these indicators was done, based on what was set internationally and
in SA Water Supply and Sanitation Policy (DWA, 1994). Relevant policy documents
and legislations available in SA were also outlined. Involvement of more women in
the water sector could bring the realisation of the burden given to women in terms of
water provision. If women are empowered they could easily employ the strategies
53
that will lighten the burden of diseases on their families as well as public health
burden.
A formula based on the water quantity accessed and distance travelled by the
household was developed to assist on the WSA’s to measure the level of services
provided to its communities. The outcomes are measured against the quantity and
quality of water provided based on the analysis done as well as the level of risks that
could be incurred by such a community. However the indicators that are
benchmarked omit some elements that are important for inclusion in the water
service indicators. Hence, the review indicated the importance of using water
service indicators as WSA’s performance monitor and measurable outcome of the
service provided to communities. To assess its performance based on the scores
developed, WSA’s could measure its performance and the level of score will
determine where interventions need to be taken. This will trigger the need to make
the analysis of the challenges that impact the service rendered. If WSA’s have a
way of measuring sustainable water service delivery, more effort could be made to
correct the situation and compliance to the policy.
The following are gaps identified based on this review:
There are limited studies providing evidence of beneficial, consequences of
water service indicators on the availability and accessibility in rural communities;
No rapid methods to calculate water quantity and accessibility per capita used in
rural areas are available;
54
Benchmarking of availability and accessibility of water based only on the
distance and volume of water, but no proper risk scores are used for
measurement and monitoring of service;
There are limited studies based on the existing water service indicators and risks
that might be incurred by the communities as outlined both in SA and
internationally, in addition to the availability of risks scores on the current basic
water indicators;
Household water safety management is mostly based on water treatment,
storage and education, as well as risk analysis not included in Water Supply and
Sanitation Policy White Paper;
The formula and scores outlined could be used as a better method of quantifying
the level of service to WSA’s. However, it should be noted that this review did
not look at the financial or economic issues and measurement of right to water;
Access and in depth analyses in terms of public health outcomes; only risk-based
analyses were done. There were a number of ways proposed to quantify water
service level but not tested, therefore to assess the level of service, water safety as
well as the management of water at household level, research in the form of case
studies was conducted in different villages as outlined in the methodology.
55
CHAPTER 3: METHODOLOGY
3.1 INTRODUCTION
The study was conducted in case studies in two different settings. This Chapter
clarifies the meaning and type of case study used and describes the population and
the setting, data collection tools and methods used. Case studies involve the
description of real life situations that could point to the development of certain
theoretical concepts (Creswell, 2007). A case study may simply involve individuals,
documents and instruments (De Vos et al., 2007). The information gathering
includes the use of interviews, observations, archival documents or records (Yin,
2009). The type of case studies available include an intrinsic case study which aims
at the understanding an individual case, an instrumental case study which aims at
gaining understanding on social issues and the collective case study which is used
by the researcher to understand the population being studied (De Vos, 2007).
To conduct a holistic enquiry into this study, a desktop review, as indicated in
Chapter 2, and two case studies were conducted to investigate the environmental
health practices related to household water safety management. The study further
determined the need for a household WSP in rural settings. Data collection methods
used included interviews, observations and the use of questionnaires. Literature
review included policies, water service level indicators and water standards used in
SA as well as in International communities similar to those in South Africa.
56
3.2 THE THEORETICAL FRAMEWORK OF CASE STUDIES METHODOLOGY
The case study areas selected for the study were aimed at providing more
understanding on the way in which household water safety and management is
undertaken within the household. This confirms the validity of the theoretical claims
made by Larry (2002), who indicated that case study methodology is used by the
researcher who has an interest in the specific subject and wishes to build an
understanding by applying other data collection methods such as observations,
interviews, historical events and the comparison of cross-case relationships.
The first case study investigation based its investigation on the historical event which
occurred in the setting towards the investigation of household water safety
management. The area was selected based on the cholera outbreak, which
happened seven months prior to the study. The outcome of this case study
determined the framework on household WSP. This case study was done to
motivate the descriptive research questions for the study which is “What and How?”
as outlined in Chapter 1 (1.3.2) (Siggelkow, 2007).
Case study 2 differs by its diverse nature of the area in terms of water supply and
setting. The first case study setting was conducted in a dry water scarce peri-urban
area where the water supply was not reliable; the second case study setting was a
rural area with plentiful water and various sources used for domestic activities. An
in-depth study was done in case study 2, scrutinising households on environmental
health practices related to water safety management. An assessment of both
57
physical and microbiological analysis was done to determine the public health risks
from the source to the POU. These studies were built on the foundation of the WSP
model as outlined on the literature review in Chapter 2. All case study investigations
were based on the real life situation in rural and peri-urban areas.
3.3 DESCRIPTION OF STUDY SETTING
3.3.1 Case study 1
The study was conducted in deep rural areas of the Nwanedi, Vhembe District,
Limpopo Province, situated next to the border of SA and Zimbabwe. Communities in
the area experienced a cholera outbreak from November 2008 to April 2009 and a
total of 720 confirmed cases were reported in VDM, South Africa (Ismael et al.,
2013). The cholera outbreak was caused by travelling from Zimbabwe to South
Africa, contaminated drinking water and lack of sanitation infrastructure (UNICEF,
2009). Seven villages selected to participate in the study were affected by the
outbreak as indicated in Figure 3.1. The purpose of selecting the case study area
was to follow-up on the behaviour of the household’s members and to investigate the
way in which they were managing their drinking water after the cholera outbreak.
The water supply in all the villages was unreliable and people relied on other sources
such as springs, rivers and irrigation canals for household water use, as indicated in
Figure 3.2 (Jagals, 2006; Majuru, 2010). The community used these sources as
their reliable and alternative supply.
58
Figure 3. 1: Map of Nwanedi Area (Oxi explorer maps 2010)
Figure 3. 2: River water used for drinking purposes
59
The water sources are located on the street where residents collect water and
transport it to their households, as shown in Figure 3.3. The water is usually stored
in containers. The study conducted by Jagals (2006) proved the deterioration of
water quality from the source to POU due to poor environmental hygiene practices.
During the outbreak, an extensive health education programme on environmental
hygiene, water treatment and good water safety practices and management was
provided to the communities by both governmental and non-governmental
organisations in order to eradicate the spread of cholera (DWA, 2009).
The methodology used to reach the communities included door-to-door campaigns
and meeting the community at their usual gathering places such as schools, health
facility, community halls and traditional council’s gathering places (UNICEF, 2009).
The area is composed of farming areas which lack sanitation infrastructure and
situated next to springs and rivers which are used as an alternative water source.
Most of the farm workers are foreign nationals who stay on the farms and use river
banks to defecate; this same water they use for drinking and domestic chores. The
media and distribution of educational materials, such as brochures and pamphlets,
demonstrates how to use water treatment methods as shown and posters were used
to provide information on how to prevent cholera (DWA, 2009).
These communities were at risk as their domestic animals used the same alternative
water sources and it was discovered, a few months after the outbreak, that the
animal faeces was a carrier of Vibrio cholerae (Keshav, Potgieter & Barnard, 2010).
Further information about the village water supplies were obtained from water
60
operators and village leaders, as summarised in Chapter 4 (4.3). The purpose of the
study suited this investigation due to the way in which water was accessed in the
rural setting, as well as the outbreak response that led to cholera eradication due to
in-depth health education.
Figure 3. 3: Communal water collection point
61
3.3.2 Case study 2
Case study 2 was chosen in two different areas, based on the nature of water
availability. The study was conducted in the peri-urban area of nine villages at
Sinthumule consisting of Magau, Madombidzha, Tshikwani, Gogobole, Hamantsha,
Ravele, Madabani and Muraleni; Tshifhire village was on its own as shown in Figure
3.4. All villages at Sinthumule were located on semi-arid land where water is scarce,
while Tshifhire is located in a mountainous area composed of rivers and springs.
Distribution of drinking water taps in the villages was inconsistent and a distance
from each other.
The water sources were not reliable and communities spent more days without water
supply (Nengovhela, 2006). Privately drilled wells found in households are used as
an alternative water supply when the communal taps run dry, as indicated in Figure
3.5. Taps on the street were used as the primary water source (Figure 3.6). The
community collected water from the street taps to the households by carrying 20ℓ or
25ℓ container on their heads, using light delivery vehicles or wheelbarrows.
62
Figure 3. 4: Sinthumule and Tshifhire study areas (Google maps, 2010)
63
Figure 3. 5: Sinthumule setting and distribution of private drilled water tanks
Figure 3. 6: Communal water collection point- Sinthumule village
64
Tshifhire area is situated in a mountanous rural area (Figure 3.7), which consists of
various water sources such as protected springs, water treatment plant, taps on the
street distributed evenly and some of the households having tap connections in their
yards. Taps are used as the communal water source, whereas other sources are
used as alternative when there is no running water at the tap. Communities carry
water containers by head or by wheelbarrows to transport water containers to their
homes. Water from the springs was connected from the mountains to some of the
households as a means of improving reliable access to water. The communities did
most of the connections themselves and had contributed money to buy and plumb
the water from rocks over the mountains to their households to ensure continuous
water supply.
Figure 3. 7: Tshifhire setting
Sinthumule and Tshifhire villages add value to the studies due to their diverse nature
in terms of water access and availability. Supplementary information about the
65
village water service were obtained from the village water operators and traditional
leaders, as outlined in Chapter 4 (4.3). An in-depth study on household water safety
management, in terms of environmental health practices in water scarce and water
abundance area, was carried out to assess differences in terms of household water
safety management and to evaluate the need for household WSP in comparison with
case study 1.
3.4 STUDY DESIGN
The study used mixed methods to answer the research questions and objectives.
Literature review was used to scientifically outline issues on water services delivery
and to understand how water accessibility, availability and potability relate to WSP.
The risk analysis, based on the review of water accessibility, availability and
potability, was made to develop a way of measuring services rendered by WSA’s.
The results are reported in Chapter 2 of the study and form the basis of WSP as
discussed in Chapter 6.
Surveys were also done for both case studies. Both qualitative and quantitative study
designs were used. Graziano and Raulin (2010) describe a survey as the
description of current state of affairs and character of the study population. It allows
the researcher to acquire information from the individual or one of more groups of
people by asking a set of questions (Leedy & Ormord 2005). Hence, allowing the
relevant and large population to be part of the study as outlined by the researcher.
The method is more descriptive than analytic (Andres, 2012).
66
A structured questionnaire was prepared to guide the interviewee on the question
which needed to be asked. The questionnaires contained both open-ended and
close-ended questions, as shown in Appendix A and B. This method follows a set of
prepared questions. The advantage of using a structured questionnaire is that the
researcher can gather a lot of data, clarify questions to the respondent and data
obtained from the households is comparable and easy to synthesise and analyse
(Johnston & Vanderstoep, 2009). The disadvantages are that if respondents are
asked questions, it could be time-consuming and very expensive as the interviewer
should be trained and a pilot study conducted (Johnston & Vanderstoep, 2009).
Observations were also done to supplement the data obtained from the
questionnaires. It allows the researcher to record behaviour or character as it
happens and more reliable (Andres, 2012). The method could take time and not be
cost effective, depending on the type of observations done (Graziano & Raulin,
2010). Literature review, observations and survey were done for case studies 1 and
2 to ensure quality data was obtained. Case study 1 data collection was a
preliminary study that informed the development of tools for case study 2. Water
quality studies were undertaken to supplement the data for case study 1, to find out if
there was a relationship between environmental health practices in households and
water the community uses. Detailed data collection and sampling is outlined below.
67
3.5 DATA COLLECTION AND SAMPLING
3.5.1 Questionnaire development for case study 1
The development of the questionnaires used for case study 1 was done in
conjunction with the main question of the study, which needs to be answered as
outlined in section 1.3.1 (see attached Appendix A). The secondary question of the
study related to case study 1 and found in section 1.3.2 of Bullet 2. This was
completed based on follow-up made after the cholera outbreak, which occurred 7
months prior to the study being conducted.
A consent form was attached to the questionnaire and was read and signed by the
respondents to signify consent being given (Appendix D). This was the first set of
documents read and explained to the participants to obtain permission prior to any
completion of questionnaires.
When the interview was conducted, the critical issues asked were:
Water sources;
Water collection;
Water availability;
Water use;
Water service before and after availability of taps and
Communication on water service.
All participants gave consent prior to data collection (Appendix D). Permission was
granted by the village leaders to continue with the studies. Higher Degree and
68
Ethical Committee of Tshwane University of Technology approved the tools used for
data collection (Appendix C). The researcher and the field workers used paper and
pen to administer the questions and a tape recorder was used for the participants
consent.
3.5.2 Case study 1 data collection
The study was conducted in 11 rural villages of Vhembe District in Limpopo Province
as a follow-up after the cholera outbreak and formed part of the baseline survey to
assess water services and household water treatment as one of the requirements for
WSP. The study was conducted in 2009. All the villages under the study were
affected by the cholera outbreak from 2008 to April 2009, prior to the study being
undertaken. Data was collected 7 months after the outbreak.
All respondents who participated in the study were found at different water collection
points. Groups comprised of 2 to 10 members. The selection criteria used was that
all participants should be living in the same village where the study was being
conducted, should have witnessed the cholera outbreak 7 months ago and each one
of them should represent one household. Members who did not live in the area of
investigation were not allowed to participate. Groups were asked a set of questions
to obtain a true reflection of village life related to drinking water management after an
outbreak. Behaviour in terms of household water practices was scrutinised to gain
an understanding of everyday life. Twenty one groups participated in the study and
a total of 152 participants were reached representing specific households.
69
A set of questions was used for all groups to determine the sources of water used
and availability, environmental health practices and the way in which water is used,
stored and treated in the households, as well as the type of communication and
environmental health education provided (Appendix B). The respondents were
allowed to answer some of the specific questions related to the individual household
practices, such as water-treatment method and who was responsible for the
treatment of water at household level. The respondents were grouped according to
the answers they had given when data was analysed.
3.5.3 Data collection and questionnaire development of case study 2
3.5.3.1 Data collection plan case study 2
Prior to the collection of case study 2 data, a planning meeting was held at
Schoemansdal, in Vhembe District. The purpose of the meeting was to plan how
data would be collected and to inform Sinthumule and Tshifhire community how the
study was to be conducted. Community participation and engagement was viewed
as one of the important criteria to build the understanding of what needed to be done
prior to the commencement of the study. This was done to ensure the community
was informed prior to any household visit. Giving information to the community on
time prepared the community, which in turn increased participation and also assisted
the researchers and field workers in not encountering any difficulties when entering
households. Issues discussed were as follows:
70
Date and period for data collection;
Selection and appointment of field workers;
Training of field workers;
Pilot study area selection;
Visit to Tribal Authority;
Visiting households;
Taking water samples;
Budgetary needs which included logistics such as accommodation, food and
working tools;
Arrangement to use the laboratory for water analysis and
Data management and quality check.
Discussions were held and the planning finalised, followed by a visit to the Tribal
Office and the laboratory to be used for water quality assessment. In March 2011,
the training of eight fieldworkers was undertaken. The discussions included the
understanding and administration of the questionnaires as well as standard
operation procedure when entering and collecting data from the households, as well
as time and work schedule. Field workers were trained on how to use the GPS and
how to follow the selected households. The training was followed by field training
held at the study area.
3.5.3.2 Study population and sampling case study 2
All households at Sinthumule and Tshifhire villages were marked using GPS to get
the coordinates and waypoint addresses. A total of 201 households were randomly
71
selected to participate in the study; 121 from Sinthumule villages and 80 households
from Tshifhire. The total number of households available in that village determined
the number of the households chosen in each village. The chosen households were
not forced to participate in the study but they did so voluntarily. The informed
consent form was read or explained to the head of each household and included the
following: the introduction of the researchers, objectives of the study, household
selection, what was expected from the households, explanation of the rights as well
as confidentiality.
If any member of the household was not available to respond on behalf of the family,
one of the matriarchs was chosen by either the head of household or by the research
team after an individual assessment. All households chosen were given the right to
withdraw from the study. When the household members agreed to participate, the
consent form, as shown in Appendix D, was explained and given to the household
respondent to sign. Permission was requested from the head of the household to
participate in the study prior to data analysis. Permission to conduct a study was
granted by community leaders.
3.5.4 Consent form
The fieldworkers read and explained everything about the study and all activities that
were undertaken during the study, as indicated in Appendix D, for both case studies..
Case study 1 consent forms were completed and signed at the point where
participants were found. In case study 2, in order for the household to be enrolled
into the study, the head of the household or his/her representative granted the
permission for the family to participate by appending his/her signature. Where the
72
respondent could not read and write, verbal permission was granted using a digital
recorder.
3.5.5 Diarrhoea disclosure
To measure the health impact on the water quality and hygiene practices, the
household members, through the respondents, were asked to recall their status of
diarrhoea in the past week. Previous week diarrhoea recall was made to encourage
the participants to remember if they had loose stools in the three days following each
other to meet case definition of diarrhoea. Diarrhoea was defined as an indicator of
stomach upset caused by either a virus or bacteria and was typically characterised
by loose stools that were passed for three days or more. Bacteria normally found in
the human stomach, as well as drinking water, more specifically E. coli strains and
the presence of the E. coli and other total coliform were used as positive indicators of
faecal pollution in drinking water. It has been proved that contaminated water and
hygiene practices in households’ causes acute and chronic diarrhoea (Ferrer et al.,
2008).
Although some strains are toxigenic, the majority of E. coli found in the mammalian
gut and faeces are considered non-pathogenic (WHO, 2008). Therefore,
International and National guidelines accepted counts of E. coli to be <1/100mℓ in
potable water; for more details refer to Chapter 2 (Table 2.2). Diarrhoea data was
also collected from the health facilities, used by the communities, where the study
was conducted (Appendix C and L). Although information was collected on the
prevalence of diarrhoea in households, the data was not used due to low response
73
rate. Supplementary information is needed to make the information valid for analysis.
However lack of health data did not affect the study as water quality data and other
environmental health data on household water practices were obtained.
3.5.6 Questionnaire development
The development of all questionnaires used for case study 2 was done in
consideration of the primary question of the study, as outlined in section 1.3.1 of
Chapter 1 and the secondary questions in section 1.3.2 bullet 3, 4 and 5. The main
questions informed the design, measurement and data collection instrument used for
the study. The required critical information included the demographic data, hygiene,
water treatment, water availability and accessibility.
3.5.6.1 Questionnaire structure for case study 2
Case study 2 used similar questionnaires in all study areas (i.e. Sinthumule and
Tshifhire). The development of questions was also based on the main question
mentioned above. The sampling and instruments tools used for data collection were
the same, as was the analysis of the data. The tools were tested for validity and
reliability before being used, as outlined in Section 3.6. The structure of the
questionnaire, as outlined in Appendix B, was as follows:
The questionnaire composed of Section A and Section B, as attached in appendices
D. Section A was based on general demographic questions, whilst Section B was
water related data. Section A included the following:
74
Section A: Demographic data
Question 1: Respondent information;
Question 2: Household members’ information;
Question 3: Household income and migration;
Question 4: Household expenditure;
Question 5: Utilities and commodity;
Question 6: Housing;
Question 7: Energy uses;
Question 8: Health and
Question 9: Personal and Domestic Hygiene.
Section B: Water
Question 10: Water collection;
Question 11: Water Usage;
Question 12: Water availability;
Question 13: Water Accessibility;
Question 14: Container hygiene and storage;
Question 15: Storage conditions;.
The training and review of questions was made to limit errors. The questionnaire
was checked to see if it addressed the questions asked and if there were any
spelling errors. The pilot study was then conducted to pre-test the questionnaires to
ensure they were valid and consistent.
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3.6 PILOT STUDY
3.6.1 Introduction
Thabane et al. (2010) defined a pilot study as a small scale study conducted to test
the methodology and procedures used to collect data. He further outlined some of
the reasons to conduct pilot study which included experimental, exploratory, test,
precautionary, trial and trying out. A pilot study is referred to as a feasibility study,
but Mubashir et al. (2010) recommended that the two should be clearly defined as
they have different meanings. Most researchers conduct a pilot study to test the tool
and procedures to be used for a large upcoming study, to confirm the tool is valid
and reliable (Arnold et al., 2009).
Joppe (2000) defines the reliability as the concept that shows the consistency of
repeatability of the same results when the same tool is used. In order for the results
to be valid, the tool should test and measure what it is supposed to measure. This
testing strategy is mostly used for a quantitative approach, but recently there was a
shift on the use of strategy in qualitative research, according to Golafshani (2003). It
was the intention of this pilot study to ensure the tools and procedures to be used
were tested for validity and reliability before being used in a large-scale study.
3.6.2 Background of pilot study setting
A pilot study was conducted at Mpheni area, in Vhembe district of Limpopo Province.
The purpose of conducting the study was to test the study’s feasibility, the
76
questionnaire tool used and the standard operating procedures used by the field
workers when collecting data from the households. This was done to test if the tool
and the procedure used in the study could measure and produce the same
outcomes when repeatedly used.
3.6.3 Fieldwork procedure for pilot studies
Permission to conduct the pilot study was given by the community leaders of Mpheni
village. Convenient study design was used to select 30 households that were
included in the study. The field study took the data from the households where
people were available. The field workers and the researchers ensured that enough
questionnaires and consent forms and pens were available and a bag in which to
place the completed questionnaires. When field workers entered the household, the
household members were greeted and an introduction of self was made. Permission
was requested from the head of the household to outline the purpose of the visit and
how long it could take to complete the whole questionnaire. Once the head of the
household agreed the consent form was read and explained and the head of the
household responded or made a decision to either allow or deny the household
members to participate. When permission was granted, the person who would
respond on behalf of the household was chosen by the head of household, if he
chose not to be a respondent. The field workers continued with data collection.
After the completion of the questionnaire, the household members were thanked and
the fieldworker continued to the next household. At the end of each day, all
questionnaires were handed to the study leader for quality checking by ensuring that
77
all questions were answered as well as to see if the field workers understood the
questions in the same way as outlined. Where there were gaps, misunderstanding
and challenges, the matter was discussed immediately and marked on the
questionnaire for amendment before the next study commenced. In cases where
questions were skipped, due to misunderstanding, clarifications were made and the
fieldworkers were urged to go back to the household immediately and complete the
questions. The criteria used to check the answers on the questionnaire was to see if
the intended answer was answered, as well as to check the replication of information
that was given; where any person who may conduct the same study under the same
circumstances could find similar information as per objectives of the study. The data
obtained was measurable based on the outlined of the study questions. The
questionnaire was checked to see if researcher could accurately draw a conclusion
and relationship between the data collected. The study was considered to be sound
as it has been conducted within the communities that represent a real life-setting.
The content was good except for a few questions that were added for clarification.
3.6.4 Questionnaire adjustment
The overall questions were good and there were only two additions on page 9 of the
questionnaire: question number 8.6 ‘Condition triggered diarrhoea’ and 8.6 on the
‘treatment of diarrhoea.’ There was confusion on question number 8.2, which
required the ‘number of people affected by diarrhoea in the past week’, where the
fieldworkers could not understand if it was a report from the whole family or only the
respondents. That question was clarified, as the total number of diarrhoea cases in
the family was needed. All questions identified were added to the questionnaire.
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3.7 DATA COLLECTION CASE STUDY 2
3.7.1 Household survey
A questionnaire survey and observation was conducted in 201 households and 121
were randomly selected from Sinthumule villages consisting of Magau,
Madombidzha, Tshikwani, Gogobole, Harahantsha, Ravele, Madabani and Muraleni;
whereas 80 households were randomly selected from Tshifhire village. All villages at
Sithumule are located in semi-arid land, while Tshifhire is located in mountainous
area composed of rivers and springs. Each household was marked using GPS to
get the coordinates and waypoint address. A unique number was assigned to each
household. The coordinates and household numbers were exported to a Microsoft
Excel spreadsheet and selected using random sample. A structured questionnaire
and observations were used as data collection tools in each household selected. A
paper and a pen were used to record all the information from the respondents and
through observations.
3.7.2 Water quality assessment
Water quality assessment refers to the physical and microbiological water quality
analysis of drinking water used in households, to determine the way in which safe
water management is practiced from the drinking water sources to the POU. A total
of 240 water samples were taken to assess the water quality. One hundred and
twenty water samples were taken from the water stored at the point of use, such as
storage containers found in households and further 120 samples were taken from
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the drinking water source where water was collected, such as communal stand
pipes, private drilled wells, tanks and springs. Water samples were analysed for
physical parameters that included pH, turbidity and electrical conductivity and
microbiological quality that included total coliform, E. coli and enterococci. Duplicate
samples of (500mℓ) were collected aseptically in each sampling point using sterile
Wharl packs. All samples were immediately placed in a cooler box at 4°C,
transported to the laboratory within an hour and analysed within 6hrs from the point
of collection.
3.7. 2.1 Detection of physical parameters
The Physical parameters detected included pH and electrical conductivity (multi-
electric electrode-HQ40D HACH was used) and turbidity (portable turbidity meter-
HACH 2100P used). All instruments were calibrated following manufacturer’s
instructions to ensure they produce reliable and valid information. A total volume of
200mℓ of water was poured into a beaker and both electrodes immersed separately
for recording of the values, as prescribed by the manufacturers and according to
standard practice. The results were then recorded and compared with the
recommended standard as outlined in SA National Standards (SANS 241-2011).
Instruments were verified prior to use to ensure valid and consistence values.
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3.7.2.2 Detection of microbiological parameters
The detection of microbiological parameters (total coliform, E. coli and enterococci)
were done using the Quanti-Tray® - Colilert 18 method (IDEXX, 2001a), Quanti-
Tray® and Enterolert 18 method respectively (IDEXX, 2001b). Duplicate water
samples (500mℓ) were collected from the household water containers and their
respective drinking water sources where the household water stored in containers
was collected. A hundred millilitres (mℓ) of water was poured into two anti-foam
100mℓ bottles, mixed with the Colliert-18 medium for total coliform as well as E. coli
and Enterolert medium for enterococci. Samples were mixed to dissolve the medium
and then contents poured into a well-marked Quanti-tray plate. The Quanti-tray was
then sealed by passing it into a Quanti-tray sealer to ensure it was not leaking. The
Quanti-tray was then incubated for 18h at 37°C for E. coli and total coliforms and for
24h at 41°C for enterococci (IDEXX, 2001b).
The yellow well indicated the total coliform presence and further assessed for the
presence of E. coli by screening under UV-light. Any fluorescence from the yellow
wells was detected as positive E. coli. Enterococci plates were also viewed under
UV light as their plates don’t change colour. However, all fluorescence wells were
counted as positive enterococci. The counts detected were then compared with the
table to find the Most Probable Number (MPN) of counts that were recorded as
Colony Forming Unit (CFU/100Mℓ).
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3.8 DATA ANALYSIS
3.8.1 Case study 1 data analysis
All data were entered into Microsoft Excel spreadsheets. Questions were coded and
similar responses were grouped together to have meaningful data interpretations.
Most of the groups that participated in the study were composed of women.
Variables such as water sources used, treatment practices and methods were
included in the analysis. To determine the type of water sources the respondents
were using, analyses were carried out taking account of the particular water-
collection point in the village where the respondents resided.
The question on water treatment was analysed differently as there were various and
sometimes divergent opinions in terms of the responsibilities and treatment of water.
Where respondents gave diverse answers, members of the groups were clustered
and subdivided according to their particular response. The mean and standard
deviation was used to obtain a true reflection of the information given by the
respondents. Quotes made during group interviews were also recorded and
reported as it is.
3.8.2 Case study 2 data analysis
All data collected was entered into Statistical Package for the Social Sciences
(SPSS) version 18. Descriptive frequencies were used to measure the distribution of
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variables, whilst Anova tests were used to compare the mean of more than two
variables. Kruskal Wallis and Wilcoxon tests were also used to observe if there were
any significance statistical variations between variables. Data was presented in
tables and figures. Water quality was also entered into Statistical Programme of
Social Science (SPSS) version 18 and descriptive analyses were done. One-Way
ANOVA test was used to determine the median and comparison of the differences of
physical parameters between and within water sources at 95% confidence level.
Kruskal-Wallis and Wilcoxon Signed Ranks Tests were used to compare
microbiological water results.
3.9 SUMMARY
The study used multiple methodologies to determine the way in which environmental
health practices could affect safe water management within the households. The
main purpose was to determine the risks in drinking water that could be incurred in
households and affect water quality, to determine the need for household WSP. An
outline and framework on how the case studies were conducted was also outlined.
The outline and the description of cases were chosen based on the nature of what
was happening at the area of study (Case study 2); while case study 1 was based on
the disease outbreak that happened seven months prior to study. All cases
investigated were based on the exploration on how the people live or behave in
terms of water management and environmental health practices in order to
emphasise the theory of WSP and household water safety management. Water
quality assessment from the source and POU were analysed for both physical and
microbiological water analysis. Study population, data collection and analysis were
83
also discussed. The outcomes of the cases could suggest inclusion of household
water safety in policy.
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CHAPTER 4: RESEARCH FINDINGS
4.1 INTRODUCTION
In this Chapter, the findings on the topic “domestic safe water management in poor
and rural households” are presented and interpreted. The findings consist of two
case studies conducted in VDM, Limpopo Province, SA. Case study 1 was
conducted in rural villages of Nwanedi area whereas; case study 2 was conducted in
rural and one peri-urban area i.e. Tshifhire and Sinthumule villages.
Case study 1 investigated the way in which the safe water management practices
were done seven months after a cholera outbreak. It answers the secondary
question in section 1.3.2 bullet 2. The study-included issues such as water service
level, environmental hygiene, water treatment and type of education received or
communication during and after the outbreak. Table 4.1 outlines the demographic
information; type of water sources used and the level of service received by the
community.
Case study 2 is an in-depth survey conducted in households to scrutinize water
management and environmental health practices related to hygiene. Case study 2
answers the secondary questions in section 1.3.2 bullet 3 and 4. The main purpose
was to investigate the manner in which safe water management practice done at
household level and its effect on water quality. The investigation included issues
such as demographic composition grouped in accordance to socio economic status;
85
household water use, accessibility, availability, water treatment, environmental
hygiene and water quality. The methodologies of each case study are elaborated in
Chapter 3.
4.2 DEMOGRAPHIC COMPOSITION OF THE STUDY
Case study 1 was conducted in 11 villages of VDM, Limpopo Province, SA in 2009
after seven months of cholera outbreak. Twenty-one (21) groups participated in the
study and a total of 152 participants were reached representing specific households.
There were more females (142) participating than males (10). Total number of
respondents in each group ranged from 2 to 10 with a mean of 7 as indicated in
Table 4.1. It further outlined the number of groups per village and the level of
service as presented below.
In case study 2 demographic information gathered from households was grouped in
accordance with socio-economic status presenting number of people in the
households from <3, between 4-5 and ≥6; followed by the description of the level of
education grouped according to different grades i.e. <grade 10, grade 11, grade 12
and tertiary level. Households were further grouped according to the level of
income; households with total income of < R1000, >R1000-R2000 and >R2000 were
also grouped respectively. The remaining data presented indicates households with
onsite water and toilets as outlined in Table 4.2.
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Table 4. 1: Demographic composition and water service level of study area: case study 1
Name of Village and group no.
no. of People in a group
Females Males Description of water service level in each village
There was no water tap water available at Tanda village. The community in the area depended on Vhembe District Municipality (VDM) Tanker that provided water at least once per week though it was mostly not reliable. Each household was allowed to collect only one container which is not more than 25ℓ per household. The alternative water sources were taps that were in nearby village, Folovhodwe and river which were more than 200m away. It was observed that the stand pipes supported by 5000 ℓ reservoir which was not yet functioning were still under construction. Generally the containers observed were having greenish layers and not closed by the lid. Health education was given in November 2009 during the time of cholera outbreak. Communication on the new project was done. The communication on the time for VDM tanker to bring water was not done at all as there was no consistency in delivering the water.
Tanda 1 7 6 1
Tanda 2 6 6 0
Tshapinda 1 7 7 0 Tshapinda village had street taps since 2007. Generally, the community was satisfied with the service they were getting. The water opened every day from 05H00 to 13H00. They collected water using various types of containers according to the need. More water is being used as compared to previously before the taps were installed as some of the community members have their own household gardens. The tap water was nearer less than 200m as compared to river water. Water was usually not available for two days or less but it was acceptable by the community that such incidences do happen. Only animal drinking happened in the river but laundry was done in the households using water collected from the tap. Education on water was done during cholera outbreak and also during the study that was conducted before the taps were installed. In case of water shortage the operator and the community leaders informed the community on time.
Tshapinda 2 8 8 0
Tshapinda 3 9 9 0
Thondoni 1 6 5 1 Thondoni village was provided with tap water since 1999 and 2001 and nothing changed since then. The water is opened from 5H00 to 10H00 and the community collects water using containers as much as they want. In low slope area, the water is always available as compared to high slope area. The water is still available and the cut off is usually two days to a week due to breakdown, the community leaders always inform them in case of breakdown. Health Education was conducted
Thondoni 2 8 7 1
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during the cholera outbreak and the research study done in the area years ago. Laundry and animal drinking is still done in the river. Few households have water inside their yard and they have paid a fee to Water Service Provider to do so. Hygiene for the containers was still the same as greenish layer was observed in most of the containers with small opening.
Tshikwarakwara 1 10 10 0 Tshikwarakwara village was provided with taps since 2004. Previously they were solely depending on canal and river. In case of a breakdown they went back to the canal and river because they were nearer. The distance for street taps is improved. They are so much satisfied on the technology used to collect the water. Scooping water using mugs was strenuous to most of them though containers are used. To some the distance has improved while others use tap water for drinking only and do other domestic activities with water from the canal as it is much nearer. The water is available from 5H00 to 11H00. The community is generally satisfied about the service rendered. The state of containers is still the same as greenish layer was observed to most of the containers with small lid. Health education was provided during cholera outbreak. Laundry and animal drinking is still done in canal and river. Those living next to taps use more water from the tap while those living next to canal and river use more water from such sources.
Tshikwarakwara 2 8 8 0
Tshaluwi 1 6 5 1 Tshaluwi area was provided with tap water since 1998. The distribution of taps is far away from other members of the community as the distance ranges between 300m to 500m. The water is scheduled to come out from 05H00 to 11H00 every day. People who travelled distances greater than 200m complained that they do not have chance to fetch enough water for domestic activities. In other part of the area, they contributed money so that they can place the tap on the street next to their households. They are now satisfied with the volume of water they get every day. Some of them are having household gardens. Scheduling of water times was done through the communication with the public where agreement was reached. In case of breakdown the public is also informed which is usually not taking more than 48 hours. They never got any Health Education. Hygiene of the containers was observed and greenish layer was spotted inside the container. Public prefer water inside the yard than on the street.
Tshaluwi 2 9 8 1
Tshitanzhe 1 6 0 1 Tshitanzhe community was provided with tap water in 2007. Previously borehole pumps and spring water were used. At the time of Focus group interview there was no water at the taps. The drilled well was no longer having water. The operator was still waiting for the Technical assistance from VDM to determine the root of the problem. The water was scheduled to be provided from 14H00 to 17H30 every day. That was communicated with the community as a whole. During breakdown the village water committee in each block is given relevant information to pass it to other members of the community. The community hired Operator and paid his salary. The community paid R10 per household to pay for the transport to collect diesel from VDM and pay the operator. Due to shortage of water from the tap, the community was using two boreholes available and spring water though
Tshitanzhe 2 11 2 2
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they knew water from the spring was not safe. River water was used for laundry and animal drinking. They benefited a lot from the tap as the distance was shorter and the technology used was simple to them. The water was safe and more water was accessed. Some of the community members started gardens that they could not sustain due to shortage of water as the distance was far.
Musunda 1 3 1 0 Musunda community got tap water since 2007. Their reticulation system was linked with Tshitazhe as they receive water from the same source. Since the drilled well has dried up the community is using river and the borehole pump. No communication was done during water cut-offs. The taps were nearer to the people but the borehole is far away from other households. The community uses less water for their domestic activities. Some of the people still use river and spring water to avoid queuing as they believe that nothing will happen to them as they drank the water since they were born. The green layers inside the containers were observed and there were no lids in most of the containers especially those with narrow openings. Community claimed they didn’t receive health Education related to water. Each household contributed R10 for diesel and payment of operator.
Musunda 2 6 0 0
Gumela 1 10 10 0 Gumela village was provided with tap water in 2008. The community was using river water before they were provided with taps. The tap water opened at 06H00 to 10H00 and at 15H00 to 18H00. Maintenance was done by VDM. Most of the containers observed were clean but not closed with lids. Communication of the water project which was undertaken was done. In case of water shortage, the communication was done through the community leaders through the operator. Each household paid about R10.00 for diesel collection and payment of operator. The tap water is benefiting the community as they now drink safe water, travelled less distance of not more than 200m and the simple technology was used. Water was always available and accessible. They operator communicates with the community in terms of breakdown. Water was available most of the time and breakdown took less than 48 hours in most instances. Community preferred to have taps in their yards. Health education was given only during cholera outbreak.
Gumela 2 6 5 1
Tshitandani 1 3 3 0 Tshitandani village is the smallest village with 13 households. The community was provided with 10000ℓ water tank. The Water service provider (VDM) filled up the tank. The community usually phoned VDM to come and fill the tank. Households exchanged with each other to Phone VDM so that the water could be filled. In cases when the tank was empty, the community goes back to the river. Community confirmed they do not treat the water. Health education was given in December 2008 during the cholera outbreak.
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Tshikotoni 1 7 6 1 Tshikotoni was provided with tap water since 2008. The water is opened at 06H00 to 10H00 and at 15H00 to 18H00 the same as Gumela. Each household paid R10.00 for Diesel and operator payment every month. In case of water shortage, river water was used. Community used river water for laundry and animal drinking. The water was often available and accessible and breakdowns do not take long to be fixed. The distance travelled is now less than 200m as compared to the river water. There is an improvement to the volume of water collected for domestic use. More water is being used for various activities especially cleaning households and washing bodies.
Dzumbama 1 7 7 0 Dzumbama village had tap water since 1999. The Electricity pump was used to pump water to the tank then to the taps. The distribution of taps was far away from other households; between 300m to 500m. Old people and other members of the community complained of the distance. An amount of R800 was needed to connect water into the yard. Most of them complained that they do not have the money for yard connection. The water was always available and collected as they wished and according to their needs. Community leaders communicate with communities when there is a breakdown. Health Education was given during cholera outbreak. The volume of water collected depended on the proximity of the water source. The container greenish layers were observed inside and they were unhygienic.
Dzumbama 2 9 9 0
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Table 4. 2: Demographic information of case study 2
Table 4.2 shows that a total of 201 households were included in the study, with 80
households from Tshifhire and 121 from Sinthumule villages. About 26% of
All Tshifhire Sinthumule
N % N % N %
Number of Households N 201 100 80 40 121 60
No. of people in the house 1 - 3 people 53 26 18 23 35 29
4 - 5 people 66 33 25 31 41 34
6+ people 82 41 37 46 45 37
Highest education N 198 80 40 118 60
<Grade 10 44 22 16 20 28 24
Grade 11
51 26 18 23 33 28
Grade 12 52 26 25 31 27 23
Tertiary 51 26 21 27 30 26
Monthly income N 193 100 80 41 113 59
<R1000 62 32 17 21 45 40
>R1000 - R2000 68 35 33 41 35 31
>R2000 63 33 30 38 33 29
Water on-site
N
196
100
78
40
118
60
available 64 33 36 46 28 24
not available 132 67 42 54 90 76
Toilet on-site
N
193
100
73
38
120
62
available 182 94 70 96 112 93
Not available 11 6 3 4 8 7
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households in both villages consist of 1-3 family members, 33% with 4-5 and 41%
with 6 members and above. It further indicated that 22% of the households had
members with grade 10 and less while those who had grade 11 , 12 and some form
of vocational training, college or university or did any kind of post educational training
each had 26% . The study further indicated that 32% of households had an income
of less than R1000, 35% were in between R1000 and R2000; while 33% had income
of more than R2000. Out of 196 households recorded, 33% were having water
connections inside their yards, of which Tshifhire was observed to have more on-site
water systems (46%) than Sinthumule villages with 24% only. The majority of
households have toilets available inside their yard.
4.3 DESCRIPTION OF WATER SERVICE LEVEL IN EACH VILLAGE
4.3.1 Type of water sources used and availability
Figure 4.1 represents the type of water sources used in the villages of case study 1.
Taps had been installed in 8 of the 11 villages between 1998 and 2008. Community
members were satisfied with the water service level during the time when water was
available from the taps. Of the 3 villages without taps, 2 were supplied by water
tankers delivering water and 1 still used river water as their only source.
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Figure 4. 1: Water source types used by the groups within study area (n=21)
Though the Municipality provided water through the use of tanks, the provision of
water was not consistent and the volume of water allowed was less as they were
allowed to fetch only one 20ℓ or 25ℓ container per household as described in Table
4.1. Nevertheless on the day of interview, groups were using a range of water
sources.
On the day of the interview only 6 groups from 3 villages claimed to be sourcing their
drinking water from the village taps. Scheduling of opening and closing tap water
was done in 5 villages between 4 to 7 hours as described in Table 4.1. That was
acceptable for most of the community members though others were concerned and
about it as per statements quoted from various groups: “There is no water from the
drilled well it seems it has dried out”. Water is only pumped from 16h00 to 18h00”.
We now use borehole water for drinking as well as spring and river for other
Borehole 14%
River 29%
Tank 14%
Community taps 29%
Mixed source 14%
Borehole
River
Tank
Community taps
Mixed source
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activities”. Of the 11 groups from 5 villages who were not using the taps, 3 were
using water from boreholes, 5 were using river water and 3 were using various
different sources including river, canal and spring water.
The reason why group members with taps installed locally were not using the tap
water was that the taps were dry on the day of the visit. Groups that were using tap
water on the day of the visit claimed that their water source was generally available.
Only 2 of the 6 groups commented that their tap water did not always have water as
per following comments. “Sometimes the water is not available for the whole week.
The tap is scheduled from 15h00-17h30. The drilled water is now dry and the water
is no longer available we are waiting for the municipality Technicians to come and fix
it”.
In one group the participants reported that they used river water and in the other
group they walked to other taps further away. It was noted that even when people
reported using a supplied source they often had to resort to river water. Three
groups from 2 villages who had water delivered by tanker all 3 stated that they had to
revert to river water regularly because of delays in delivering the water. In summary,
despite the fact that 17 of the 21 groups reported having communal taps installed in
their villages, only 6 (35%) were using these taps on the day of the visit.
The only other improved water supply was boreholes used by three groups from 2
villages. Consequently 12 of the 21 (57%) groups reported using an unimproved
water source on the day of the visit. Another group reported that although they were
using tap water on the day of the visit they often also had to revert to river water
during failures in supply. Groups were not happy about scheduling of water. Most of
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them preferred continuous and reliable water supply. However situation at
Sinthumule and Tshifhire villages were different as outlined in Table 4.3.
Table 4. 3:Household water sources available at Sinthumule and Tshifhire
villages
In case study 2 presented in Tables 4.3 and 4.4, Sinthumule villages that include Ha-
Magau, Madombidzha, Tshikhwani, Tshiozwi, Ha-Mantsha, Ha-Ramahantsha, Ha-
Ravele, Muraleni and Madabani as well as Tshifhire village described the level of
water sources used and the level of service provided by WSA in each area. Both
villages are having street taps just like other villages in case study 1 as indicated in
Table 4.3. Majority of households found in Sinthumule villages do not have water
All Tshifhire (village name) Sinthumule (village name)
Primary Water Source % N % N %
Yard standpipe 42 21 33 41 9 8
Communal standpipe 87 43.5 27 34 60 50
Borehole 9 4.5 0 0 9 8
Tank 1 0.5 0 0 1 1
Spring 17 8.5 17 21 0 0
Private drilled well 41 20.5 0 0 41 34
Other 3 1.5 3 4 0 0
Total 200 100 80 100 120 100
Alternative water source
Yard standpipe 10 6 1 2 9 10
Communal standpipe 11 7 5 8 6 7
Borehole 6 4 0 0 6 7
Tank 13 8 0 0 13 14
RWH 3 2 0 0 3 3
Spring 54 35 54 83 0 0
Private drilled well 54 35 1 2 53 58
Other 5 3 4 6 1 1
Total 156 100 65 100 91 100
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inside their yards except those with own private drilled wells. Tshifhire households
were having 370 on-site water connections.
Table 4.3 and 4.4 show that despite the availability of taps at Sithumule, the taps
were usually dry and not having consistent water supply as outlined in Appendix F.
The villages depend on private drilled well as their alternative or secondary water
supply. Tshifhire villages were having springs as alternative water source, of which
some members of the community used it as their main or primary source; though
majority used it when there is no water available on the taps as indicated in Table
4.4. The taps from Tshifhire are supplied by a small treatment plant whereas the
taps at Sinthumule villages are supplied by boreholes. The majority of those who
had water connection in the yard were found in households at Tshifhire village as
shown in Table 4.3.
Table 4.5 indicated the socio-economic status of facilities in the households. In
terms of availability of pit latrines, Table 4.5 indicated that there were no major
disparities as compared to the availability of on-site water systems. Water
connections in yard were found in households with grade 12, tertiary education and
income of greater than R2000.00 (51%) were having water connection in their
households as indicated in Table 4.5.
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Table 4. 4: Water service level of study area: Case study 2
NAME OF VILLAGE BRIEF DESCRIPTION OF WATER SERVICE
Ha-Magau There were at about 38 street taps but only two taps were having water and the rest of the taps were dry. Community depends on these two taps as well as private drilled wells.
Madombidzha The area had at least 173 street taps of which most of them usually do not have water (about 127 taps non-functional). Street taps with running water are very few and the taps could take up from two weeks to a month without water. Water was not coming out from some of the taps due to salt build-up of which it was the main problem to the rest of Sinthumule area. The new stands in the area were not having water at all. The Municipality provided the community with water tanks which were not usually filled up with water. The tanks were filled once in two weeks. Most of the community in this area depends on buying water from those having drilled well in their households.
Tshikhwani This area differs from Madombidzha area as the water was available at least two days per week. There were at least 19 taps available, of which 9 of them are not having water due to salt or mineral build up. Private drilled wells are usually taken as the alternative source during water cut off.
Tshiozwi The area was having 50 street taps. At the time of way pointing most of the taps were having water after two month of not having water at all. About 15 of the taps were not having water due to salt build up. Usually community took up to more than a week without running water. The pattern of water availability in the area is not stable or predictable. Intervention method used is private drilled wells available in the area. The new area in the village is provided with tanks that take up to two weeks without water.
Ha-Mantsha There were 42 street taps available in the area. The community was much better when compared to other villages. They usually have water available for at least three days a week though the water does not last for more than 5 hours. The problem of salt build up in taps is the same as in other areas. About 10 taps does not function due to salt build up. Buying water from private drilled well owners was an alternative way of having water in their households.
Ha-Ramahantsha At least 47 street taps were available in the area. The water availability in the area was not stable as they could run short of water for a week, two weeks or a month. Most of the community depends on private drilled wells available in the area. The salt build up in taps and distribution channel is a problem the same as in other areas above, as about 14 taps were non-functional.
Ha-Ravele There were at least 57 street taps. The water was scheduled to open only during weekends from Friday to Sunday though sometimes it happens that the water comes out midweek. The community claimed that it could take up to two weeks without running water. When water is available, it cannot take more than four hours. Salt build up in distribution channels and taps is usually a challenge. The community depends also on private drilled wells when water was not available.
Muraleni There were 28 street taps in the area. The water availability in the area came out at least once or twice per week. It took up to two weeks to a month without water from the taps. Salt build up is also a problem. The community depends on private drilled wells when water is not available.
Madabani There were at least 27 street taps in the area. The availability of water was unpredictable. They can have water once or twice per week. They can take up to a month without water. The salt build up is usually a problem in the area. The community depends on private drilled well in case of water shortage.
Tshifhire (Maelula) The area used different sources. The community used treatment plant and springs as their drinking water sources. About 370 households had water in their yards. There were at least 27 street taps in the area. Due to the area itself which is mountainous, it taps were not provided to the rest of the community. Some parts of the area did not have water at all but depends on the springs available in the area. Some of the community prefer spring water than potable water which its quality was not known.
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In case study 2, the unavailability of water was recorded weekly in 49% of
households of which17% took up to 6 months without water in communal water
standpipes as indicated in Table 4.6. Fourteen Households using spring water
source (93%) and 21 (60%) with yard connections reported shortage of water of up
to a year. There was a significant difference of (p<0.05) at 95% confidence level of
water availability in various sources.
Table 4.6 and Figure 4.2 showed that in all communal water sources available; no
source could supply consistent water in any household for 24 hours as shown in
Appendix E. Figure 4.2 indicated that of all water sources, the most reliable sources
were springs followed by private drilled wells and yard standpipes that were often
connected to drilled wells and taps connected to a spring and communal pipes.
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Table 4. 5: Water service level of study area: case study 2
Table 4. 6: Unavailability of water in sources
All Sinthumule Tshifhire 1 - 3 people
4 – 5 people
6+ people
<10th grade
1- or 11 grade
Grade 12 Tertiary <1000R 1 - 2000R
>2000R
All 201 121 80 53 66 82 44 51 52 51 62 68 63
Water on site
Available 64 28 36 12 23 29 7 11 20 26 10 18 33
Not available
132 90 42 41 40 51 35 39 32 23 51 47 29
Pit Latrines
Available 182 112 70 51 55 76 36 47 50 46 55 62 58
Not available
11 8 3 1 7 3 7 2 0 2 4 5 2
Type of water sources daily weekly monthly bi-monthly 6-monthly Annual
Yard standpipe 1(3%) 11(31%) 2(6%) 10(11%) 0 21(60%)
Communal standpipe 9(10%) 43(49%) 6(7%) 0 15(17%) 10(11%)
Tank 0 0 1(100%) 14(93%) 0 0
Spring 0 0 0 2(11%) 0 14(93%)
Private drill well 2(11%) 3(16%) 0 47(30%) 12(63%) 2(11%)
Total 12(8%) 57(36%) 9(6%) 5(3%) 27(17%) 47(30%)
99
Figure 4. 2: Cumulative frequency (%) of unavailable water supplies (yard etc. water sources)
4.4 HOUSEHOLD WATER TREATMENT
The question on household water treatment presented with various diverse answers
from the groups and household respondents in case study 1. The response
obtained from villages showed that there was a widespread belief amongst groups
and respondents that the WSA or the supplier treated their tap water, when
available; which was generally not the case. The response on the question on
household water treatment, presented from individuals in this case study indicated
that it was not possible to get consensus within the groups as individuals varied in
their treatment of water prior to drinking. Of 152 participants, only 21 (14%) reported
using any form of household water treatment. About 9 stated that they boiled water
before drinking and 12 used bleach. There was very little difference on the use of
household water treatment between those using improved (15%) and unimproved
0
20
40
60
80
100
120
daily weekly monthly bi-monthly 6-monthly
yard standpipe
communal standpipe
tank
Spring
private drill well
Total
100
(13%) water sources. When asked why they did not treat river water the community
generally did not think this was important. A typical and common comment was “We
do not treat water from the river because it is long time that we drink the water and
nothing happened to us”.
In case study 2, of the 151 people who answered the question on drinking water
treatment, 31% agreed. However, when asked how they treated their water only 52
answered. Four people said they boiled their water and 14 claimed to use bleach
and the remaining 34 answered other. When questioned further 34 people
responded that they believed VDM treated the water, even though the water
connection was from the spring. The results indicated that very few households treat
their drinking water before use regardless of the source used as shown in Appendix
K.
4.5 CONTAINER HYGIENE
The majority of the households used containers to collect and store it. However,
most of the containers observed were not hygienically clean and the greenish layer
of biofilm was seen inside them. In case study 2 the most common containers used
were plastic containers with narrow (38%) open screw mouths as well as the plastic
containers with wide mouth provided with lids (22%) as indicated in Table 4.8.
During the survey a total of 232 containers were checked inside to see if there were
clean or having biofilm or any movement of loose particles. The type of containers
used included plastic containers with narrow open top screw, plastic container with
101
narrow closed screw, plastic screw with wide mouth open and plastic screw with
wide mouth closed. Out of 38% plastic narrow screw open containers observed,
biofilm was in 44% of them. Thirty three percent of closed narrow plastic screw
containers with wide opening showed loose particles. About 46% of containers
observed on the inside were clean as indicated in Table 4.7.
Hundred and eighty-two containers were observed from outside to assess their
hygiene conditions as shown in Table 4.7 The criteria used to observe containers
were categorized by clean, very dirty or having excessive scratches. Clean
container-means here a container without scratches, biofilm or any foreign layer
inside. Dirty container represent container with layers of soil inside and outside as
well as foreign particles and layers attached to the container.
Each container was inspected according to its type. Containers with narrow open
plastic screw were very dirty (31%) whereas 26% presented excessive scratches.
Thirty two percent of narrow closed screw containers showed excessive scratches
while the rest were clean (see Table 4.7). The hygiene of the container did not show
any difference in terms of socio-economic status as shown in Table 4.8 and
Appendix I. All those who went to a level of tertiary behaved the same to those with
lower grades, with highest number in the house and those earning a salary of greater
than R2000.
102
Table 4. 7: Container hygiene inside and outside
Open plastic screw top
Closed plastic screw top
Open plastic wide mouth
Closed plastic wide mouth
N % N % N % N %
Container hygiene on the inside
Biofilm 39 44 7 12 10 29 5 10
Loose
particles
14 16 19 33 10 29 21 42
Clean 36 40 32 55 15 44 24 48
Total 89 100 58 100 35 100 50 100
Container hygiene on the outside
Very dirty 28 31 3 5 8 23 8 16
Excessive
scratches
24 26 19 32 12 34 14 29
Clean 39 43 37 63 15 42 27 55
Total 91 100 59 100 35 100 49 100
103
Table 4. 8: Hygiene condition of containers as per socio-economic status
All Sinthumule
Tshifhire
1 - 3 people
4 - 5 people 6+ people
<10th grade
1- or 11 grade
Grade 12
Tertiary
<R1000
R1000 - R2000
>R2000
201 121 80 53 66 82 44 51 52 51 62 68 63
Container hygiene outside (open screw)
Very dirty 28 12 16 7 8 13 7 9 9 3 11 10 6
Excessive Scratches
24 12 12 6 5 13 4 8 8 4 8 8 8
Clean 39 38 1 8 16 15 7 13 9 9 19 10 8
Container hygiene outside (closed screw)
Very dirty 3 1 2 2 0 1 2 1 0 0 2 1 0
Excessive Scratches
19 2 17 4 8 7 4 3 4 8 2 7 9
Clean 22 3 19 11 11 15 9 7 8 13 8 15 14
Container hygiene outside (open wide mouth)
Very dirty 8 0 8 2 2 4 3 1 1 3 2 4 2
Excessive Scratches
12 3 9 4 3 5 3 3 5 1 5 4 3
Clean 15 6 9 2 9 4 1 5 6 3 2 8 5
Container hygiene outside (closed wide mouth)
Very dirty 8 3 5 2 3 3 3 1 2 1 3 3 2
Excessive Scratches
14 2 12 4 4 6 4 2 2 5 2 5 6
Clean 27 10 17 6 13 8 3 3 10 11 5 11 11
104
Table 4. 9: Container’s prior use
Out of 173 households, Table 4.8 indicates that 21% of containers used were new
and 37% used to store chemicals.
4.6 CONTAINER CLEANING METHODS
The majority of households used 20ℓ or 25ℓ containers with narrow or wider mouth as
indicated in Table 4.8. There were various methods used for the cleaning of
containers as indicated in Table 4.10. A consistent majority of the households (59%)
reported that they clean-up their containers using soap, water and sand that was
mixed with soil found on the ground where water was collected every time before
they fill in their containers.
Container prior use N %
Newly bought 36 21
Carry foodstuff 62 36
Carry chemicals 64 37
Other/ not sure 11 6
Total 173 100
105
Table 4. 10: Container cleaning methods
There were 28 households who had private drilled wells that were plumbed and
connected to a tank. Households having tanks connected to private drilled well in
the yard were found at Sinthumule villages only. About 36% of the households
reported that they clean their tanks at least once in a month or once after six months
or once in a year, while 46% were not sure when they last cleaned their tanks and
18% never washed their tanks since installed (see Table 4.11).
Cleanliness and container hygiene was not informed by the number of people living
in the same household, level of education or income as indicated in Appendix H.
There was no difference between the educated and the non-educated in terms of
container’s cleanliness as indicated in Appendix J. All households used a variety of
methods to clean their containers.
Cleaning method N %
Rinse outside only 2 1
Rinse inside-out 11 6
Wash with soap 9 5
Wash with soap inside out 11 6
Wash with soap and sand inside-out 102 59
Wash with sand only inside out 10 6
Other 29 17
Total 174 100
106
Table 4. 11: Frequency (%) of cleaning water Tanks connected to a Private
Drilled Well
4.8 CONDITION OF HYGIENE IN PLACES WHERE WATER IS STORED
Most of the households stored their water inside their houses as shown in Table
4.12. It was noted that about 319 rooms were used to store water. The rooms
where water was mostly stored were cool and dark (41%). About 31% of the rooms
were clean while less than 30% were not clean and could likely contribute to water
contamination.
In terms of socio-economic status as indicated in Table 4.13, the level of education,
number of people in the household and income does not determine the place and
the hygiene conditions of where water was stored.
Sinthumule (village name)
Cleaning of tanks N %
1 week 0 0
1 months 3 11
6 months 3 11
1 year 4 14
Never 5 18
Not sure 13 46
Total 28 100
107
Tablet 4. 12: Condition of place where water is stored
Sinthumule N %
Container storage
Inside 187 98
Outside 3 2
Total 190 100
Condition of storage
Cool and dark 130 41
Hot and light 33 10
Dusty 11 3
Dirty floor 14 4
Dung floor 5 2
Clean 98 31
Insects visible 2 1
Animal access to water 2 1
Children access to water 23 7
Other 1 0
Total 319 100
108
Table 4. 13: Condition of hygiene where water is stored according to socioeconomic status
All Sinthumule Tshifhire 1 - 3 people 4 - 5 people 6+ people <10th grade Grade 11 Grade 12 Tertiary <1000R 1000 - 2000 >2000R
201 121 80 53 66 82 44 51 52 51 62 68 63
Container storage
Inside 187 107 80 49 61 77 40 49 47 48 59 67 56
Outside 3 3 0 1 1 1 1 0 2 0 2 0 1
Condition of storage
Cool and dark 130 57 73 37 40 53 32 34 29 33 33 52 44
Hot and light 33 17 16 6 15 12 7 8 11 5 11 12 9
Dusty 11 10 1 3 5 3 2 5 4 0 5 3 3
Dirty floor 14 4 10 2 4 8 1 5 6 2 6 5 3
Dung floor 5 3 2 2 0 3 3 1 1 0 2 2 1
Clean 98 81 17 27 35 36 21 25 22 28 37 29 26
Insects visible 2 0 2 0 1 1 0 0 2 0 1 0 1
Animal access to water 2 2 0 1 1 0 0 2 0 0 2 0 0
Children access to water 23 10 13 1 11 11 4 6 5 8 9 7 7
Other 1 1 0 0 0 1 1 0 0 0 0 0 1 Water scooping
Scooping vessel used 185 107 78 49 58 78 40 47 48 47 55 66 57
Tip container used 8 7 1 2 4 2 0 3 3 2 5 1 2
Other 2 0 2 1 0 1 1 0 1 0 1 1 0
Keeping insect away from containers
Using cloth 129 71 58 37 38 54 26 35 37 31 39 49 37
Using lids/caps 73 32 41 15 30 34 15 15 25 21 21 29 27
Using insect Repellent 20 15 5 2 9 9 6 4 3 7 5 6 9
Using insect Swatter 7 7 0 1 2 4 2 2 2 1 1 5 1
No method used 9 8 1 3 3 3 1 4 3 1 5 2 2
109
4.9 ACCESSIBILITY OF HOUSEHOLD WATER SOURCES
Difficulties were observed in case study 1 among the communities where tank water
was provided by the municipality. The time schedule for the provision of water was
not consistent as indicated in Table 4.2. Communities were forced to go back to the
river which was at a distance of more than 200m. The respondents comment was
“The tanker took up to two weeks without delivering the water, and then we go back
to the river”.
The majority of the communities where tap water was provided were satisfied with
the distance from the water source. One of the villages was not happy with the
distance between unimproved and improved water sources. One of the group
members reported that they still use water from the canal for domestic sources as it
is nearer as compared to the tap water source and the comment was; “Those who
are living next to canal are still using the water for domestic chores due to nearer
distance as compared to taps”. Tap water was preferred for drinking purposes. The
old people complained of back pains because of water fetching and distance
travelled to the tap. In one village where the distance to water sources ranges from
300-500m from households, they preferred water to be provided in their yard but do
not have connection fee; and the comment was: “The water is safe and nearer to
households but we need water in the household yard is just that we cannot afford
money for household water connection. Some of us are too old to reach the taps on
the street.”
110
4.10 DISTANCE FROM HOUSEHOLD TO WATER SOURCES
In the case study 2 distances travelled from household to water sources varied.
Seventy percent of communal standpipes provided at the communities met SA water
standard of travelling distance of not more than 200m (Table 4.14 and Figure 4.3).
Table 4. 14: Distance travelled to water source
Households using spring water sources (49%) travelled more than 200m as opposed
to all other sources as indicated in figure 4.3 and Table 4.14. Majority of
households that had yard pipes (56%) travelled shorter distance of between 0-<50
as indicated in Figure 4.3.
The Kruskal Wallis test (Figure 4.4) was used to compare independent variables of
water sources distances from the household to the water collection point. All
variables were ranked from 1-5.
Water source
0 - 10m
% > 10 <= 50m
% >50 <= 100m
% > 100 <= 200m
% > 200m
% Total %
Community
standpipe
17 21.5 14 17.7 10 12.7 14 17.7 24 30.4 79 100
Borehole 1 16.7 1 16.7 3 50 0 0 1 16.7 6 100
Tank 2 25 2 25 1 12.5 0 0 3 37.5 8 100
Spring 5 7.6 6 9.1 2 3.0 21 31.8 32 48.5 66 100
Private
drilled well
31 53.4 9 15,5 4 6.9 2 3.4 12 20.7 58 100
111
Figure 4.3: Travelling distance to Primary water sources (0.00-household percentage; 0-10m travel distance and Yard etc. water sources)
The test indicated that there were significant difference (p<0.01) between the groups.
The degree of freedom was 4 which were between the rank of 2.5. The lowest
median was 1.00 (0-10m) while the highest was 4.00 (>100m≤200m). Households
using drilled wells travelled less distances of 0-10m (53%) and there were followed
by the communal standpipes (22%).
Out of 191 households it took an average of 3.18 (SD±3.136) trips per day by each
household to collect water to a maximum of 20 trips per household. The average
waiting time spent by 187 households at the water source was about 8.0
(SD±10.458) minutes to a maximum of 60 minutes.
0.00
10.00
20.00
30.00
40.00
50.00
60.00
0-10m >10< 50m >50<100m >100<200m >200m
Yard
Community standpipe
natural
Private drilled well
112
4.11 TRIPS TO WATER SOURCES
A total of 79 households reported that they buy water when there is no water
available in their primary water sources. An average of R13.90 (SD±51.937) per
household is spent each day for 20ℓ or 25ℓ container to buy water from private drilled
wells.
Figure 4. 4: Travel distance from households to water sources using independence-Sample Kruskal-Wallis test. (1.00 (0-10m), 2.00(>10m≤50m), 3.00 (>50m≤100m), 4.00 (>100m≤200m) and 5.00(>200m)
113
4.12 HEALTH EDUCATION AND COMMUNICATION RELATED TO WATER
SERVICE
Heath education and communication was explored in case study 1. Table 4.15
shows the type of communication given to the community after the cholera outbreak.
The analysis was based on the communication related to health education and other
types of water service communication passed to the community. All groups in all
villages indicated that there was no on-going health education related to water, in 3
villages groups claimed there was no health education ever provided to them.
The community in all villages often get more other water-related communication
other than that addressing health risks. Such communications include payment of
monthly fees to the operator, hiring of the vehicle to collect diesel for water pumps,
communication in case of water shortages and breakdown, with VDM to provide tank
water as well as communication on water scheduling and project implementation. In
summary, water education related to health risks was not provided.
114
Table 4.15: Types of communication provided to the communities
Village Name Health Education related to water Type of communication often made
Tshikotoni No health education Community involved in project communication and communication of fees for operator payment.
Tshitandani Education provided only during cholera outbreak
Communication based on the phone call made to VDM to provide tank water
Gumela Education provided only during cholera outbreak
Communication done when there is water system breakdown and communication of fees for operator payment.
Musunda No health education Communication of fees for operator payment
Dzumbama Education provided only during cholera outbreak
Communication of fees for operator payment
Tshaluwi No health education Communication done when water schedule was proposed and communication of fees for operator payment
Tshikwarakwara Education provided only during cholera outbreak
no communication
Thondoni Education provided only during cholera outbreak
Communication done when there is water system breakdown
Tshapinda Education provided only during cholera outbreak
Communication done when there is water shortage
Tanda Education provided only during cholera outbreak
Communication was based on the new project in progress
Tshitanzhe No health education Communication done when there is water system breakdown and communication of fees for operator payment.
115
4.13 WATER QUALITY
A total of 240 water samples were tested for physical parameters from drinking water
sources and household storage containers. The water samples assessed for
physical parameters were tested for pH, turbidity and electrical conductivity and risk
level measured as indicated in Table 2.2. Electrical conductivity and microbiological
assessment included total coliform, E. coli and enterococci were also assessed. The
assessment was done using the recommended limits shown in Table 2.2.
From 240 water samples taken; 120 samples were taken from drinking water
sources of which 42% samples taken were from communal taps, 28% spring water,
22% private drilled wells and 9% taken from tanks that were placed by the VDM in
strategic points in areas where there was no water supply. Another 120 water
samples were taken from storage containers. Table 2.2 indicate the standard used
to determine the level of risks for both physical and microbiological analysis.
4.14 PHYSICAL PARAMETERS
The results of physical parameters shown in Table 4.16 show the mean values for
pH, turbidity and electrical conductivity for each drinking water source. The one way
ANOVA’s for each of the three parameters showed highly significant differences
between sources (p<0.01). In particular spring water was of lower pH with a median
of 7.94 (7.7-8.8.19, 95%CI), low electrical conductivity but slightly high turbidity 3.56
116
(p<0.01, 2.65-4.47, 95%CI) which is within the limit of 5 as per SANS 241-2011
(South African Bureau of Standards, 2011). By contrast both private drilled wells
and tank waters were low in turbidity and beyond acceptable limits of electrical
conductivity in private drilled well at a median of 165 (153.9-176, 95% CI; tank 158.7
(117.5-200, 95%CI). The pH values of drinking water sources complied with the
standard as shown in Table 2.3. High turbidity found in spring water could result in
harbouring microorganisms and could decrease the effectiveness of water treatment
(DWA, 2001). Where turbidity is high possibility of microbiological contamination is
high.
Table 4. 16: pH, turbidity and conductivity measurements in drinking water sources
*CI-Confident interval; F-test is the ratio of two scaled sums of square
A further 120 water samples were also taken for assessment of physical water
parameters at the point of use in household water containers. Figures 4.5 to 4.7
indicate the differences between physical parameters (pH (Figure 4.5), turbidity
(Figure 4.6) and electrical conductivity (Figure 4.7) between samples taken from the
drinking water sources and from water stored inside the containers accessed from
Water sources pH Turbidity Conductivity (mS/m)
N Mean 95%CI Mean 95%CI Mean 95%CI
Communal tap 50 8.63 8.51 - 8.74 1.28 0.81-1.75 125.6 104 - 147.3
Private drilled well 26 8.68 8.57 - 8.78 0.67 0.49-0.86 165 153.9 - 176.1
Spring 33 7.94 7.7 - 8.19 3.56 2.65-4.47 5.8 5.3 - 6.3
Tank 11 8.63 8.46 - 8.8 0.82 0.6-1.04 158.7 117.5 - 200
Total 120 8.45 8.35 - 8.55 1.73 1.36-2.11 104.2 89.3 - 119.2
F 18.0 17.6 53.5
Degree of freedom 3 3 3
P value <0.001 <0.001 <0.001
117
the same drinking water source. Figure 4.5 indicated that there was not much
difference between the pH from drinking water sources and the water stored inside
the containers. However, there was a slight change in pH of water stored inside the
container as indicated in Figure 4.5.
Figure 4. 5: Scatter plot of pH measurement between the water source used in households and water stored inside the container
118
Figure 4. 6: Scatter plot of turbidity measurement between the water source used in households and water stored inside the container
In comparison, turbidity values indicated in Figure 4.6 and electrical conductivity
shown in figure 4.7 showed that there were no changes in turbidity and electrical
conductivity between drinking water sources and the water kept inside the
containers.
119
Figure 4. 7: Scatter plot of Electrical conductivity measurement between the water source used in households and water stored inside the container
The electrical conductivity did not show any increase in values for water stored
inside the containers as shown in Table 4.17; but it was generally beyond the
acceptable limit in water accessed from private drilled wells with median of 165
(153.9-176.1, 95% CI) and tank water with median of 158.7 (117.5-200, 95%CI)
respectively as shown in Table 4.17 (South African Bureau of Standards, 2011).
Turbidity in spring water was found to be high as compared to other sources and SA
water standard though still found within the standard. Spring water recorded at the
median of 3.56 (2.65-4.47, 95% CI) which was >1 and <5 that is within the
recommended standard.
120
There were differences in pH values between water from the source and container
stored water; though most of the values were between the acceptable limit of 6.5 to 9
and median of 8.45 (8.35-8.55, 95%CI) (South African Bureau of Standards, 2011).
Table 4.18 further indicated that there were significant difference (p<0.01) in pH
values, turbidity and electrical conductivity from the different water sources.
Table 4. 17: One-way ANOVA output between physical parameter in water sources
Table 4.17 indicates the significant difference (p<0.01) in pH values, turbidity and
electrical conductivity from different water sources. The pH, turbidity and electrical
conductivity in spring water, communal tap, private drilled well water and tank water
were different according to the type of water source.
ANOVA
Sum of Squares df Mean Square F Sig.
Source_ pH Between Groups 11.799 3 3.933 17.964 <0.01
Within Groups 25.397 116 0.219
Total 37.196 119 Source_Turbidity Between Groups 158.593 3 52.864 17.572 <0.01
Within Groups 348.981 116 3.008
Total 507.574 119 Source_Conductivity (mS/m) Between Groups 471441.2 3 157147.1 53.54 <0.01
Within Groups 340476.8 116 2935.145
Total 811918 119
121
4.15 MICROBIOLOGICAL QUALITY OF DRINKING WATER SOURCES AND
WATER STORED IN CONTAINERS.
Tables 4.18 and 4.19 show the concentration of bacterial counts that include total
coliforms, E. coli and enterococci in different drinking water sources as well as from
the storage containers. The results of drinking water sources tested are presented in
Table 4.18. From Table 4.18 the total coliforms were detected in 76% of the samples
(i.e.≥10 per 100ml) often at very high counts. Over half of all the samples had
counts of >200 coliforms/100 ml with samples from the communal taps having better
quality although coliforms were still present in 50% of the samples. All water
sources showed contamination by faecal matter, as the total coliform counts were
very high. The spring, private drilled well and tank water sources were among the
most contaminated by total coliforms. Container stored water was slightly higher
than in other water sources when total coliform and E. coli counts were compared.
The presented data suggest that drinking water sources that were used in the area
of study constitute a public health concern. E. coli which is used as an indicator
microbe of faecal contamination was found in low counts. By contrast E. coli was
detected in 37% (≤ 1 per 100mℓ) and enterococci in 58 (≤ 1 per 100mℓ) of samples
although counts were generally much lower. Spring water was much more likely to
contain faecal bacteria than other water sources because it was unprotected from
environmental contamination. Of particular interest is the finding that although
enterococci were present more frequently than E. coli in all water source, spring
water, tank water and private drilled wells water had higher counts as compared to
communal drinking water sources, although private drilled well water showed a
122
contamination of 65% (≤ 1 per 100mℓ). The study demonstrates that drinking water
sampled at the source and in the household was frequently contaminated with
indicator bacteria since total coliforms, E. coli and enterococci were detected in most
samples.
Enterococci bacteria reflected higher counts than water drawn in water sources.
There was an increase of contamination in water stored in containers (71%) although
E. coli (< 1/100mℓ) was lower at 39% as shown in Table 4.19. However, this was
statistically significant difference on the concentration of enterococci in container
water as compared from the counts found in water sources (z=-3.270, p<0.01) when
the Wilcoxon Signed Ranks Test was used. In general container water samples
were more likely to be contaminated by enterococci bacteria as it reflected higher
counts than water drawn.
Furthermore an independent sample Kruskal-Wallis test was used to determine the
significant differences between the total coliforms, E.coli and enterococci counts in
drinking water sources as shown in Figures 4.8, 4.9 and 4.10. A significant
difference of (p<0.001) was recorded in drinking water sources
123
Table 4. 18: Concentration of microbiological counts in water sources
Microbiological parameters
Microbiological counts in water sources
Water sources
0 CFU/100mℓ
% 1 to 9
CFU/100mℓ
% 10 to 99
CFU/100mℓ
%
100 to 200
CFU/100mℓ
% >200
CFU/100mℓ
% Total %
Total coliforms Communal tap
25 50 11 22 2 4 1 2 11 22 50 100
Private drilled well
0 0 4 15 3 12 1 4 18 69 26 100
Spring 2 6. 0 0 0 0 1 3 30 91 33 100
Tank 2 18 0 0 4 36 1 9 4 36 11 100
Total 29 24 15 13 9 8 4 3 63 53 120 100
E-Coli Communal tap
41
82 6 12 2 4 0 0 1 2 50 100
Private drilled well
21
81 2 8 1 4 1 4 1 4 26 100
Spring 4 12 17 52 11 33 1 3 0 0 33 100
Tank 9 82 1 9 0 0 0 0 1 9 11 100
Total 75
63 26 22 14 12 2 2 3 3 120 100
Enterococci Communal tap
33
66 10 20 6 12 0 0 1 2 50 100
Private drilled well
9 35 12 46 3 12 0 0 2 8 26 100
Spring 6 18 10 30 13 39 4 12 0 0 33 100
Tank 2 18 6 55 2 18 0 0 1 9 11 100
Total 50
42 38 32 24 20 4 3 4 3 120 100
124
Table 4. 19: Concentration of microbiological counts in container water
Microbiological counts in containers
Microbiological parameters Water sources 0
CFU/100mℓ %
1 to 9 CFU/100mℓ
% 10 to 99
CFU/100mℓ %
100 to 200 CFU/100mℓ
% >200
CFU/100mℓ % Total
Total coliform
Communal tap 10 20 6 12 7 14 3 6 24 48 50 100
Private drilled well 0 0 4 15 5 19 2 8 15 58 26 100
Spring 9 27 1 3 4 12 0 0 19 58 33 100
Tank 0 0 0 0 2 18 0 0 9 81 11 100
Total 19 16 11 9 18 15 5 4 67 56 120 100
E. coli
Communal tap 33 66 9 18 3 6 1 2 4 8 50 100
Private drilled well 15 58 6 23 4 15 1 4 0 0 26 100
Spring 17 52 6 18 8 24 1 3 1 3 33 100
Tank 8 73 1 9 1 9 0 0 1 9 11 100
Total 73 61 22 18 16 13 3 3 6 5 120 100
Enterococci
Communal tap 16 32 11 22 20 40 1 2 4 8 50 100
Private drilled well 4 15 11 42 5 19 3 12 3 12 26 100
Spring 13 39 6 18 12 36 1 3 1 3 33 100
Tank 2 18 2 18 4 36 1 9 2 18 11 100
Total 35 29 30 25 41 34 6 5 8 7 120 100
125
Figure 4.8: Independent-Sample Kruskal Wallis Test of Water Sources
Figure 4. 8: Independent-Sample Kruskal Wallis Test of Water Sources Contaminated with total Coliforms. (box- 25th centile, 0- out layers, * extreme out layers).
126
Figure 4. 9: Independent- Sample Kruskal Wallis Test of water sources contaminated with E. coli. (box- 25th centile, 0- out layers, * extreme out layers).
127
Figure 4. 10: Independent- Sample Kruskal Wallis Test of water sources contaminated with enterococci. (box- 25th centile, 0- out layers, * extreme out layers).
128
To give a clearer indication of the cumulative counts in drinking water sources,
Figure 4.11 indicates the concentrations of enterococci counts in each sources
starting from the highest to lowest counts. As indicated in Figure 4.11, communal
taps have the lowest counts, spring and tank water have the highest counts followed
by private drilled well water this shows the risk of drinking water used in households
as compared to E. coli counts as outlined in Table 4.18 which is not usually common.
Figure 4. 11: Proportion of drinking water counts with enterococci counts in
drinking water sources
Although both enterococci and E. coli were detected much less frequently than total
coliforms, enterococci were present more frequently than E. coli and this was
especially the case in private wells.
0
10
20
30
40
50
60
70
80
90
1 10 100 1000
Per
cen
tage
Enterococc/100ml
Communal tap
Private drilled well
Spring
Tank
129
4.16 SUMMARY
The study findings in Chapter 4 show the diverse information on the way in which the
communities access their water. The use of both primary and alternative water
sources was dependent on the settings in each community. However majority of
communities use communal water as their primary source. Hence, few of the
communities use spring, rivers and private drilled well as their primary source. The
unavailability of communal taps influence communities to use other sources as either
primary or alternative sources. The findings further indicated that in some cases
water was not available in communal water sources from a day up to a year. It is
clear from this findings that communities become vulnerable to use anything which is
available as their alternative source as long as the water is accessible and available
despite its level of risk. Potability of water was not the main issue. Distance travelled
to access alternative water sources was recorded to be up to 5km but the source
was used despite its distance and potability.
Factors that could cause health risks to communities includes sources of water used,
access, distance and hygiene. Location of water sources influenced the
communities to store water in containers which were not clean. Hence the primary
use of container and condition where it is placed make it vulnerable to
contamination. Water quality show that some communal water sources were
contaminated. Alternative sources shows higher contamination than the primary
source. However, treatment of water was done by only few members of the
community and majority of people were not treating their water despite all the risks
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found in drinking water that they use every day. Therefore, study findings show risks
in drinking water that can cause ill-health and the need for household water safety
management. Detailed discussion of the study is outlined in Chapter 5.
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CHAPTER 5: DISCUSSION
INTRODUCTION 5.1
All case studies indicated similar relationships in respect of management and
environmental health practices on household water. The challenge of household
water risks cuts across all case studies observed regardless of the circumstances
prevailing in the villages that include; history of disease outbreak, water scarcity and
availability of improved and unimproved water. The main issue that influences such
challenges is the problems of continuous access to potable water which is also
common in all areas. In addition container hygiene and environmental conditions
observed in households contribute to poor water quality and pose public health risks
to communities. Continuation of using untreated water sources for consumption
complicate the whole issue of safe water management at household level; and pose
risks to public health. In both study areas, reliability and accessibility influenced the
choice of water source used by the communities.
5.2 WATER SOURCES, ACCESSIBILITY AND RELIABILITY OF WATER
SERVICE.
The majority of communities use communal sources as their primary water source.
Despite the presence of communal water sources, due to unreliability of the system;
communities use other sources such as private drilled wells, tanks, springs, canal
and rivers. However, the study indicated that the main reason of using alternative
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sources was that primary sources provided were not reliable. These findings are
similar to the study done in Swaziland and Kenya where water shortages were a
challenge, leading to the use of unprotected water sources (Peter, 2010; Wagah et
al., 2010).
Reliable safe water at household level remains the key issue in accelerating the
health and welfare of the communities (Prüss-Üstün et al., 2008). Unfortunately,
most communities in rural areas of SA are not accessing sufficient water for all
domestic uses and so have to rely in part on alternate sources (Evans et al., 2013).
Though communal water sources were proven to be of better quality as compared to
other sources (Taulo et al., 2008); where the primary water source is not consistently
available, the safety of the community is compromised. The inability of communal
water sources to provide consistent water supply brings a lot of uncertainty to the
health risks of the communities when other unmonitored water sources are used.
Communities are forced to walk for long distances looking for water (Nnaji et al.,
2013; Hemson, 2007). Women and children, in particular, are the most affected and
have to travel long distances far from their households looking for water(Hawkins &
Seager, 2010; Arku, 2010; La Frenierre, 2008; Majuru et al., 2012).
In most instances, the distance travelled to communal water and yard standpipes
provided by WSA’s meet the requirements as stated in Water Supply and Sanitation
Policy White Paper (DWA, 1994). This study clearly showed that the short distance
to water system that does not have water does not benefit communities and it is
actually pointless to have them if water is not available as shown by the studies
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made by Hunter et al. (2009b). The study conducted in Swaziland, indicated that
failure of water infrastructures to produce volume of water needed for domestic
activities on a daily basis influences the use of unsafe water even though they are
located at acceptable distance (Arouna & Dabbert, 2010).
Despite the long distances between households and source to access spring water,
people travel to them when water is not available from communal standpipes and
yard connections. The study shows that the reliability of water is key factor in
determining the safe management of water in households. Distance to water
sources is also a key but communities are forced to travel as they cannot live without
water for consumption as per study done in Kenya (Wagah, Onyango & Kibwage,
2010). Although there is a general belief in the safety of spring water, the study
show that spring water is often vulnerable to contamination and unacceptable for
drinking purposes.
Private water sources are solution to some of the households, due to its proximity
and reliability as compared to communal water sources but their quality is often
uncertain and could pose a risk to public health. Preference of private drilled well
water as an alternative source by some communities is also a concern as some
studies had proved some of them to be of poor quality as indicated by the studies
done in SA and other developing countries (Wagah, Onyango & Kibwage 2010;
Potgieter, Mudau & Maluleke, 2006). The study confirmed that household with
improved economic status, where a person or people with some form of vocational
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studies and with total income of more than R2000 are the most found with own yard
tap or private drilled well (Appendices F).
The disparities between the poor and the rich become prevalent as access to on-site
water is determined by availability of funds or affordability in the household. The
poor households remain paying a high price for water or use unsafe water sources.
It is a common practice at Sinthumule villages for households to buy water, which
increase the burden of poverty to communities (Joubert, Jagals & Theron, 2003;.
Armstrong, Lekweza & Siebrits, 2008). However, people at Tshifhire village walk for
more than 200m to access water from springs; which could be vulnerable to
contamination as indicated in studies done in Nigeria (Itama et al., 2006). This
supports the statement by the WHO/UNICEF (2012) that the poor pay high price for
water which is usually not safe.
Unavailability of potable water was common in all villages, mainly due to
infrastructure breakdown and low water capacity in drilled wells. That encouraged
the communities to use unimproved sources, as indicated in Figure. 4.2 and 4.3.
These problems led to water scheduling and unavailability of water for weeks,
months and sometimes up to a whole year. The study revealed that it could take up
to 6 months for failures in community water supplies to be corrected, forcing the
community to use alternative sources. Communities experiencing water shortages in
communal sources showed an increase in number of diarrhoeal prevalence in
households in the studies done at Limpopo (Majuru et al., 2010).
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Springs and private drilled well water were the most reliable sources despite their
vulnerability to contamination. However, private drilled wells and spring water
accessed by households in these communities were not subject to any form of water
quality monitoring and there was no regulation that controls its safety. The studies
done in Nigeria, Madagascar, America and UK indicated poor water quality in most
of the privately owned water sources (Itama et al., 2006; Boone et al., 2011; Gelting,
2009, Atusinguza & Egbuna, 2012). The outcomes of these studies indicated that
unless safety measures are put in place prior to water consumption, communities
could be at risk of acute infectious diseases.
5.3 DRINKING WATER QUALITY
Provision of safe water without any contamination and causing health risks to the
consumers is the key in water service delivery (Hunter et al., 2009a). Apparently,
unreliable water service and environmental hygiene were the main contributors for
the cholera outbreak, which left the poor in a most vulnerable state (DWA, 2009). In
most developing countries where disease outbreaks occurred, untreated water
sources were used and waterborne diseases such as gastro-intestinal infections,
cholera and other related conditions prevailed (Said et al., 2011). However, the
cholera outbreak and access to unimproved water sources in both studies did not
influence good household water practices. One of the critical findings observed in all
villages was that treatment of water was not taken as a priority by majority of the
households. Communities relied on the municipality to treat their water; hence, it was
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not always the case. That could mean lack of empowerment and knowledge
transferred to the communities to improve their health.
The fact that the presence of pathogenic cholera bacteria was detected in cattle
manure in research conducted in the Vhembe District, Limpopo Province became an
issue of grave concern. In case study 1 villages where the findings occurred, cattle
were observed to be drinking water from the same rivers and springs that were used
by the communities as their alternative supply (Keshav, Potgieter& Barnard, 2010).
This situation highlighted the urgent need for a sustainable water-supply service and
health education to ensure that the community takes reasonable steps that could
make their water safe to use. These actions could prevent the cycle of cholera
outbreaks and other diarrhoea-related diseases that could continue to cause a public
health burden on communities and authorities.
Environmental hygiene also has a critical role to play in household water storage and
point of use. The findings in the study indicated unhygienic storage of water, which
could increase the presence of pathogenic bacteria in household water. Case study
2 demonstrated that drinking water sampled at the source and at home was
frequently contaminated with bacteria. Total coliforms were detected in most
samples. Although both enterococci and E. coli were detected much less frequently
than total coliforms, enterococci were present more frequently than E. coli and this
was also the case in private wells.
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The detection of both E. coli and enterococci in water could suggest the presents of
water-borne pathogens (WHO, 2008). All sources that were used were found with
high contamination of enterococci counts and less E. coli; meaning that drinking
water sources that were used in the area of study were of public health concern.
The most serious concern was that even the communal sources provided by the
municipality, expected to supply public with potable water was contaminated with
enterococci, E. coli and total coliforms. The recent outbreak that happened in
Northwest Province that killed three children and affected more than 500 people was
because of E. coli that was caused by spillage of sewage into drinking water (Gibbs,
2015). Everyone expected the water to be clean as it was coming from communal
water sources. This incident make emphasis on the need for potable water
monitoring in SA for public health gain. The diarrhoea outbreak happened at
Mpumalanga Province in 2005 did not cause any impact on improvement of water
quality as the Province Blue Drop rank is at 151 from 153 as compared to other
municipalities (Nelspruit News, 2013). The need for household water safety
management is important in prevention of diseases.
The other public health concern was that spring water and private drilled wells that
were used as alternative sources of water supply during water cut-offs were the most
contaminated. The study that was made in Greece detected enterococci in natural
spring water and municipal water and bio-typing successfully classify E.faecalis
strains in all sources of water that are known to be hospital acquired antimicrobial
resistant species (Grammenou et al., 2006).
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The E. coli were found at levels greater than the WHO standard of < 1 CFU per
100mℓ though some relatively low levels suggested a relatively limited degree of
faecal contamination (WHO, 2008). Most studies include E. coli as the main bacteria
to judge the health impact of drinking water (Risebro et al., 2012). It is known to
cause diarrhoea in children and other communicable diseases linked to water (WHO,
2001). However enterococci are known to survive in harsh environment while E. coli
could not survive for a long time (Colford et al., 2012). Both bacteria could cause
diarrhoea in children under the age of 5 (Risebro et al., 2012).
Similar microbial water studies in household water were observed in SA and other
countries (Ateba & Maribeng, 2011; Levy et al., 2012; Atusinguza & Egbuna, 2012).
This shows that the quality of drinking water deteriorates from the supply to the point
of use. High E. coli counts was observed in spring water where the turbidity was
also high. Turbidity is known to harbour microorganisms and deter the effectiveness
of water treatment (DWAF, 2001). It is clearly demonstrated in this results that E.
coli should not be taken as the only marker to determine the quality of drinking water
that poses health threat. Enterococci should be considered when water quality is
assessed because of the ability of other species to survive for prolonged time (Du
preez et al., 2008).
All water sources showed the contamination by faecal matter of more than 10
CFU/100mℓ the total coliform counts showed 56% of water sources with more than
100 CFU/100mℓ which is not recommended as observed in the literature (WHO,
2003; Jimmy et al., 2011). The water sources that include spring, private drilled
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wells and tank water were among the highest water sources contaminated by total
coliforms even in container water. Container stored water was slightly higher than in
water sources when total coliform and E. coli counts were compared.
The significant difference (p<0.01) was observed between sources and container
water contaminated with enterococci. The increase in enterococci might be due to
the hygiene and handling of containers at the point of use as confirmed by the study
done in SA to investigate the origin of enterococci contamination in households (Du
preez et al, 2008). However, a high number of faecal contaminations were observed
in water stored inside the containers. There were also an increased number of
enterococci detected from source to the container. These results are similar to that
of a study done in Senegal on the drinking water quality change from catchment to
consumer in the rural area indicating higher contamination of enterococci in
container water than to the sources (Sorlini, 2013).
Electrical conductivity did not show an increase in values when stored inside the
containers but it was generally beyond the acceptable limit (South Africa Bureau of
Standard, 2011). Only turbidity was showing such difference especially in spring
water where turbidity was high. The increase in turbidity in containers could be due
to the presence of loose particles and biofilm that was observed in the containers as
shown in (Appendix H). The presence of high turbidity in water indicates the
difficulty that could be faced by household members when they need to treat water.
Particles that are found in water harbour the microorganisms that could render water
unsafe to drink. The pH values between the water from the container and the one
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drawn from the source did not differ; and most of the values were between the
acceptable limit of 6.5 to 9 as demonstrated in Table 2.2 (DWAF, 2001).
Seasonal variation was also not taken into consideration; however the results were
taken throughout the whole year. There was clear evidence brought by the studies
that the detection of enterococci gave a good reflection on the status of drinking
water quality when compared with E. coli regardless of the season; though Sodium
chloride (NACL) was not tested. Household water with enterococci indicates the
faecal pollution in water, could cause risk of infectious intestinal disease (Risebro et
al., 2012). The study indicated that there is a need for policy on safe water
management at household level to ensure that household water is frequently
monitored to alert the public to take reasonable steps in managing water at the point
of use.
5.4 CONTAINER HYGIENE AND ENIVIRONMENTAL CONDITIONS OF
HOUSEHOLDS
Majority of communities in study area used container to store water. Biofilm, floating
particles and scratches outside the container were found as shown in appendix I.
The presence of biofilm in stored water was associated with the likelihood of the
presence of E. coli in the water, and created challenges on the effectiveness of the
disinfection process during treatment by the study made by Mokoena (2009).
Another experimental study conducted in some of the villages in Nwanedi areas to
test the effectiveness of hypochlorite solution in storage containers. Some of the
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community members were given placebos to use while others were given the actual
hypochlorite solution. Even though compliance with the use of the sodium
hypochlorite ranged between 60% and 100%, there was no significant difference in
microbial water quality between the two groups (Potgieter, Mudau & Maluleke,
2009). Another experimental study conducted by Jagals (2006), focused on water-
quality assessment of drinking water from both improved as well as unimproved
sources stored in containers. The results indicated that both containers were
contaminated by E. coli as there was no significant difference between the qualities
of both improved as well as unimproved water sources being stored in the
containers. Both of these experimental studies had questioned the reliability of
microbial quality when using water-storage containers for household water use.
The study also indicated the importance of proper storage and treatment as well
maintaining good hygiene condition of the containers to avoid re-contamination.
Studies on the proper water storage and treatment were done and proven to have
public health impact, though other trials were found to be bias (Hunter, 2008). The
policy on safe water management is of vital importance. However the poor state of
hygiene of other containers observed was a concern as it could have impact in
drinking water stored (La Frenierre, 2008). As documented by other researchers,
storing water inside the containers could cause health risks due to water ability to
deteriorate in quality. Pickering & Davis(2012) outlined that, inadequate access to
sanitation, poor hygiene and poor management of water at household level could
attribute to contamination of drinking water stored in containers (Pickering & Davis,
2012).
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When microbiological water samples were tested, the study also looked at the
general condition type and hygiene of container present at the households, but the
condition of each container was not recorded when a water sample was taken as
indicated in Table 4.18. However it only focused on the general quality of water from
the source and the water stored inside the container to determine any changes in
water quality. The studies only outlined issues that indicated the quality of water
used in households to outline water safety status. Majority of households use both
containers with wide and narrow screw.
The use of both wide and narrow opening containers with or without lids could also
have influence on the bacterial counts found in water. Wide containers contribute to
high contamination as compared to narrow opening containers as indicated by the
study done by Shwe (2010). The study showed the same results as half of the
containers were in poor state of hygiene which contributed to poor water quality.
The hygiene of the containers was not good as biofilm, loose particles and scratches
were observed on the container. High contamination by total coliforms and
enterococci could be due to unhygienic condition of the containers as well as the
type of the containers used. Containers with wide mouth are known to be more
vulnerable to contamination than the containers with narrow mouth (Shwe, 2010).
Similar studies showing the risk of water at the point of use were done by various
researchers (Shwe, 2010; Rufener et al., 2010). Therefore, the use of containers to
store drinking water remain unacceptable and questionable especially where
hygiene cannot be maintained.
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It was also of serious concern that some containers were found in the rooms, which
were dusty, making drinking water vulnerable to contamination. However, the use of
containers to store water poses a remarkable challenge due to container prior use.
The study revealed some of the containers were used to store chemicals which
could be fatal to the health of the community (Sorlini et al., 2013). Without
concerted action by the government in improving the reliability of its community
water supplies, the use of containers will remain in the next decades to come and
continue to cause health risks to the public.
5.5 COMMUNICATION OF RISKS IN WATER AND TREATMENT
The major concern was that the majority of the respondents in these communities
were not treating their water in both case study 1 and 2. Only a few of them were
treating water through boiling and chemical disinfection. The need for HWT at the
point of use is of critical importance in the prevention of cholera and acute diarrhoea.
Such initiatives should be underpinned by health and hygiene education in order to
improve the level of health status within these communities.
The most common method used for water treatment was boiling; and those already
using improved sources (taps and boreholes) mostly practised that. Boiling is
regarded as the oldest and most preferred method that is used globally (International
Finance Cooperation, 2009). If the method is used correctly, most of the microbial
pathogens that include bacteria and viruses can be killed (Clasen, 2009). The study
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done by Rosa and Clasen (2010) in low- and middle-income countries indicated that
boiling water was seen as the surest and most effective method commonly used to
treat drinking water at household level, compared to other treatment methods. The
advantage of using this method is that it is known and used for management of
household drinking water, food preparation or hygiene. The same type of energy
that is used to prepare meals can be used for water treatment. Its main
disadvantage is that it takes time and requires energy sources such as wood, coals,
paraffin, electricity, etc., which could be a challenge in PRH in terms of cost, if they
have to buy the fuel or travel for many hours to access firewood.
When water is heated to a boiling point, it loses its volume due to evaporation which
is a challenge in areas where access to water is difficult. The type of fuel used and
the area where water is stored are of fundamental importance as they can contribute
to re-contamination of water after boiling. Despite the disadvantages this method
should be encouraged as it could save lives of poor and rural communities with little
resources required. The DoH in SA also recommends boiling of water for effective
treatment of raw or contaminated water (SA Government Communication and
Information System, 2008). Therefore, boiling was one of the treatment methods
that were recommended during outbreak.
Respondents used chemical treatment, albeit infrequently used by those who relied
on river water for household purposes. River water is an unimproved water source,
which WHO and UNICEF Joint Monitoring Programme (2010) regard it as
contaminated even in the absence of microbiological test data. The chemical
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disinfection method was also recommended as an effective treatment method by
health promoters to disinfect water contaminated with Vibrio cholerae O1 during the
cholera outbreak in the area (SA Government Communication and Information
System, 2008). Chlorination or the use of household bleach (sodium hypochlorite) or
sachets were recorded as the most frequently used methods for disinfection of water
at household level in developing countries where it is difficult to access potable water
(Clasen, 2009). Disinfection of water using these chemicals is effective in water
treatment but it cannot kill other pathogens like protozoa and viruses (WHO, 2008).
It is said to be the fastest and most reliable method used to manage the outbreaks in
various countries and has been recently used in SA to eradicate cholera outbreaks
(UNICEF, 2009). However, as it has been pointed out, blinded randomised trials
have shown no effect on the incidence of acute diarrhoeal disease of household
chlorination (Schmidt & Cairncross, 2009). The study done by Sobsey, (2002)
indicated that treatment of water at the point of use increased public health gains
and it should be considered in all areas where water is contaminated by faecal
matter.
User literacy is important as the correct dosage is crucial to ensure the effectiveness
of the disinfectant. When using household bleach 5mℓ is needed to disinfect 20ℓ of
water in a container (WHO, 2008). The use of chemical disinfectants is limited to its
availability and cost. Most poor communities cannot afford to buy such chemicals; in
addition, it may be difficult to source these chemicals in remote rural areas where
poor communities with poor access to potable water sources are usually found.
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Communication of health risks related to water supply was observed as a challenge
by the study; especially in case study 1. Most of the communities reported to have
received health education only during cholera outbreak. However, communication
on water education was lower as compared to other type of communication that was
based on management of water service (Table 4.20). The results indicate that
information disseminated by health workers during the outbreak was not taken
seriously by most of the community members after the cholera outbreak as that was
provided only to manage an outbreak. People with limited health literacy often lack
knowledge about the body and the causes of diseases and health literacy requires
knowledge of health topics. It was shown that proficient health literacy was lacking
in these communities and they lacked the skills needed to manage their health and
prevent diseases. Therefore, the public health education provided to the
communities that depend on unsafe water did not contribute much to bring about
behavioural change of the community.
As part of the WSP, health information and services understood and used by these
communities should be provided, and health professionals should be engaged in
building health literacy. In order to promote behavioural change within communities
and long-term prevention of communicable diseases, there is a critical need for the
development of health literacy skills, as these skills empower individuals to read and
understand health information. Communities tend to forget important information
that is given once-off, and revert to their original practices or behaviour when there
are no challenges affecting their health. That was proven through the frequent type
of communication in which the community was often engaged within their villages in
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Table 4.16. The appropriate communication channels should be used to ensure that
health information translates into long-term healthy behaviour.
5.6 SUMMARY
Provision of water, which is reliable, is a key in prevention of risks that could affect
the communities. Paying high prices for water, unreliable water sources and
travelling long distances looking for water, ultimately affect the water quantity that
influence the storage of water in containers. The use of containers to store water
was common as in many other rural areas of South Africa (Potgieter, Mudau &
Maluleke, 2006). This practice is often found in households that access potable
water on the street (Evans et al., 2013).
Unreliable water supply could make it difficult for water authorities to achieve its goal.
Where sustainable water supply is a challenge, household water safety management
is essential (WHO/UNICEF, 2012). The study showed that the drinking water used
in the households was not of good quality both at the water source and when stored
inside the container despite the observation of various seasons. The need for
continuous monitoring of water sources is of vital importance. The outcomes of each
water quality status should be continuously communicated to the community. The
community should be empowered so that they can take reasonable steps of
managing their own health by knowing how to take initiative to prevent public health
risks. This could only be achieved by sustainable education in household water
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storage and treatment. It is unfortunate that the study findings indicated that the
majority of people are not treating their drinking water despite the use of unprotected
sources and storing water in dirty containers. High microbial water counts found in
sources and containers could make the community vulnerable to diseases.
Therefore, risk assessment and management of drinking water at the household
level and continuous education addressed through policy could help to increase
public health gains. The household WSP suggested is regarded as the main key to
ensure continuous access to safe water at household level; by determining the risks
prior to water consumption as outlined in Chapter 6.
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CHAPTER 6: HOUSEHOLD WATER SAFETY PLAN
6.1 INTRODUCTION
This Chapter make analysis of the outcome of the entire study focusing on
household water safety management. The study started by executing a desktop
review outlining policy implications on household water supply by comparing local
and international water indicators based on water service level indicators that include
availability, accessibility and potability. The review further made an analysis on
water service indicators. Two case studies follow the desktop study review and they
were based on the way in which safe water management was practiced in
households. Case study 1 was the follow up study made in rural areas of Nwanedi
affected by cholera in 2008/2009. Its main purpose was to evaluate any consistency
in the manner in which communities manage their water; after an extensive
environmental health education roll-out on safe water management practices during
the outbreak.
That was followed by case study 2; which was an in-depth study aimed at scrutiny of
households in terms of safe water practices and management. Water quality
analysis supplemented the outcomes of case study 2, to determine the safety of
water used by the community. The outcomes of these studies gave an idea on the
status of water service and management of safe water at household level. The
findings of the study indicated gaps on water service indicator’s standards. The
study based its findings on risk assessment in household drinking water and the
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need for WSP. Findings revealed that although Environmental health education on
safe water practices were provided during the cholera outbreak communities were
not ready to deal with risks related to drinking water and sanitation. The study
revealed various factors that contributed to public health risks such as accessibility,
availability, potability, environmental hygiene and reliability of water supply.
The use of unsafe sources was common in all villages without taking into cognisance
of the health risks. The worst scenario was that even some of the communal taps
were found contaminated with total coliforms, E. coli and enterococci. The general
outcomes of the studies indicated that drinking water used by the communities was
not safe and little effort is made by few to treat water before use. The studies reveal
the need for water safety plan at household level to prevent diseases. This Chapter
will outline the manner in which household water safety should be done in rural
areas with inadequate water supply.
6.2 OVERVIEW OF THE HOUSEHOLD WATER SAFETY PLAN
The WHO (2008) estimated that about 3 billion people lack consistence household
safe water supply and that could lead to a disease burden such as diarrhoea in
affected communities. It is further indicated that 94% of diarrhoea cases around the
world could be prevented if there is an increased availability of safe water at the
point of use supplemented by the improvement of hygiene and sanitation (WHO,
2007). Providing water which is safe, reliable, cost effective and affordable is one of
the fundamental key issues in public health. It is nearly a decade since the WSP
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model was adopted; and it is now practiced in many countries with the aim of
improving public health gains. Hence SA is also practicing WSP as part of the Blue
Drop incentive assessment up to the tap.
The Blue Drop assessment strategy is one of drinking water strategy that is used in
SA to monitor the WSP compliance of drinking water systems in its municipalities in
terms of managing the quality from the treatment plant up to the tap water on the
street at the level of the household yard with or without the meter. This indicates
government commitment in providing safe potable water to its communities (DWA,
2009). It is unlikely that WSP dwell much on tap water and not at the point of use.
The strategy does not consider the evaluation of consistent and reliable safe water
supply. Moreover it is unfortunate that most of the communities in PRH use the
small water community supply systems which are not reliable leading to the
alternative use of unprotected water supply sources. Hence, little effort is made to
render these water sources safe or empower communities through environmental
health education so that they could be aware and know when to safely manage their
drinking water.
The hygiene promotions given to these communities are not consistent, most of the
water sources are collected from the communal tap on the street and few on the
yard. Hence, it is well proven that there is a challenge in water quality deterioration
in the household at the point of use, which renders the treatment at the source
useless or waste of efforts. This may well indicates the need for managing potable
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water from the source to a household level and at the point of use for health
improvement.
There is a need for SA to shift its focus from the street tap to the household by
encouraging good environmental health practices. SA like any other country in the
world is using small community water supplies to more than half of its communities
(boreholes and small water treatment facilities). The other members of the
community who do not have safe water supply depend on unprotected sources such
as springs and rivers (Jagals, 2006). This is worrying because Census 2011
statistics revealed that the leading cause of death in children under the age of 14 is
acute intestinal infectious diseases (Census, 2014).
The WSA’s occasionally provide municipal water tankers as an alternative source in
areas where there is no safe water. Hence this is rated as the unimproved water in
terms of the WHO (2011). This practice was also observed in one of the villages in
case study 1. The challenge rests on the way in which water is managed in the
water systems used that could be either protected or unprotected sources to ensure
it become less harmful at the point of use to save many lives. In order to reduce the
threats in drinking water the WHO recommended the framework for safe drinking
water.
The framework indicates the health based targets that cover the health outcome,
water quality requirements, the required treatment as well as the type of technology
being used, while the water safety plan is described as a process control that
ensures that the water is potable and safe to the population where service is
153
provided. This should not mean 100% compliance and less than one CFU of E. coli
in 100ml of water tested but could mean at least 95% compliance with counts of E.
coli that is tolerable and not cause infection or public health risk. In order to achieve
the results of WSP in any type of water supply system, proper process control with
good operation and maintenance supported by simple approaches used for
monitoring is essential.
Setting health targets in WSP should be clearly aimed at the reduction of diseases
through benchmarking the water supply available in the area. It is meant to provide
the information that is used for monitoring and evaluate the effectiveness and
efficiency of the existing sources that are available. Areas that are usually monitored
include the water quality requirements, treatment required and the technology being
used. This stage represents the overall policy objective for water safety to determine
the acceptable risk.
In South Africa, health targets are the water standard that is set by the authority.
Currently SANS 241-2011 and DWA, (2001) are used as recommended standard for
water quality as outlined in Table 2.2(South African Bureau of Standards, 2011). It is
essential to use the QMRA model to determine what is suitable for specific
community using dose-response relationship that determine the appropriate
exposure without public health threat. The system assessment in the WSP is to
identify events that have ability to make potable water harmful and no longer fit for
human consumption within the water supply chain system. If hazards are identified it
informs the stakeholders that the water that is not potable and will become more
154
dangerous than its original state. Such analyses should prompt the stakeholders to
inform the community members to take reasonable steps to ensure the water they
use is safe. This stage should be fully described and everybody in the team should
understand it in order to identify hazardous events or threats that could change the
state of potable water as outlined in Table 6.1 and 6.2. If the community contributes
to some of the hazards, it may encourage them to stop or to become part of the
solution as outlined in Table 6.3.
Monitoring the water sources or the supply chain system is the most important step
that is aimed at identifying the risks that might have occurred in the water source
making it unsafe and not suitable for human consumption. Answers such as what,
where, how and who are important to set up a monitoring plan that need to be
documented. The monitoring plan should apply to every water source that has been
identified by the team and in the household where water is stored and used as
suggested by the framework indicated in Figure: 6.1. This stage is strengthened by
continuous surveillance which is regarded as a watchdog to immediately identify
events that will render water unsafe.
Surveillance is the most critical stage to ensure potable water is being supplied to
the relevant community where WSP is implemented. It is considered as the
continuous and vigilant assessment of the safety and acceptability of drinking water
supplies through QMRA, water quality testing, inspection and audit undertaken to set
the appropriate standard (Shamsuddin, 2008). The area of surveillance include
continuous inspection and the frequency of audit as documented.
155
When managing the water at home, surveillance should be done at the source where
water is collected, to the storage facilities at home and at the POU (see Figure: 6.1).
The technology used at the source and in the household should be taken into
consideration and that may include the use of tap, scooping vessels and the type of
container used for storage. The treatment used in both settings should also be
considered and verified whether it gives expected results as outlined in the health
target. The method of treatment and its effectiveness should also be part of the
surveillance so that when anything goes wrong corrective measured may be
implemented.
When setting the WSP the most important step is to assemble the team, starting with
the key stakeholders that are responsible for the provision of water service and
identification of the key role players at the community who are also consumers. The
inclusion of the stakeholders found in the community is fundamentally important as
there will be a knowledge gain from all those involved from the professionals to non-
professionals. Continuous communication with all stakeholders is fundamentally
important when WSP is implemented to build the foundation. All the sources of
water used within the area should be listed and described. The expected health
targets and outcomes should be documented with the whole WSP. To summarize,
determination of health targets, monitoring and surveillance are the key elements in
WSP as outlined in the framework.
156
6.3 DEFINITION OF WATER SAFETY PLAN AND RISKS ASSOCIATED WITH
HOUSEHOLD WATER SUPPLY
The identification of risks and hazard analysis towards safe management of drinking
water in households was the main core of the entire study. Risks are described as
any hazards that have potential to cause harm. The WSP has been described as a
tool used for hazard management in water to prevent any risks that might cause
harm to the consumers (WHO, 2008). WSP was introduced to ensure the
consistence provision of safe potable water. It is determined as a key factor to
ensure safe water to communities through risk identification and frequent water
monitoring (WHO, 2008).
The provision of adequate safe water supply to communities is regarded as one of
the positive signs of preliminary socio-economic development; though poor water
service delivery may require much effort in risk management to minimise public
health burden (Komenan, 2010). The importance of safe potable water in PRH is of
vital importance. The need to develop safety measures to improve water quality in
PRH from the source to the point of use contributes a major role in ensuring safe
water as many improvise access to water using unprotected sources such as
unprotected springs and rivers while most of them get water from protective sources
away from their households (Majuru. 2010).
The WSP could quickly reduce the risks that may deteriorate the water quality from
the source, water collection, transportation, water storage and at the POU.
Supplementing the safety measures by reinforcing the hygiene education in WSP
157
implementation is also considered critical in reducing the burden of diseases by 37%
(WHO, 2008). However, managing potable water to most of developing countries is
still a challenge. Most of the studies recommend Household Water Treatment and
Storage (HWTS) at the point of use as a low cost-effective method to reduce the
level of diarrhoea (Sobsey, 2002; Clasen, 2009). These researchers did not address
the sustainable way of dealing with the household water safety but agreed that there
is challenge of keeping or storing water safely in the households.
WSP at the household level supported by HWTS and sustainable education could
benefit the concept of household water potability for efficient health gains. Hence,
ensuring water safety measures through continuous water and hygiene practice
education could assist in empowering the community to take charge of their own
health by knowing what to do, when to do it and how to manage water in a
household setting. The current WSP used across the world has indicated benefits in
terms of risks mitigation and improved drinking water. Therefore, rural communities
with limited resources, require a simple Household WSP that can be understood by
every member of the family to keep their drinking water potable and safe.
In order to reduce contamination at the point of use, potable water management
during collection, storage and household water treatment at the point of use
supported by water hygiene practices is fundamentally important in the maintenance
and improvement of water quality (Tambeka et al., 2008). The use of clean and
appropriate type of container supported by good environmental hygiene for water
158
storage has been proven to prevent the re-contamination of treated water (Clasen et
al., 2006).
The review made by Clasen et al. (2007) had proved that treating water at home
reduces diarrhoea to children under the age of 5 as well as other vulnerable groups
though some of the trials done were proved to be biased. Most of the trials or
interventions were done for shorter period and not guaranteed to be sustainable after
the end of the study (Hunter, 2009). The critical issue is that household members
should know when and how intervention should be applied.
Household water treatment methods are used globally, and the treatment methods
used with number of populations that were detected to be used in 32 countries are
boiling (301.69 million), strain (204, 80 million), filtration (105,17 million), stand and
settle (49,95 million), bleach (40.93 million) and solar heat (2,3 million) (IFC, 2009).
This indicates the serious concern over safe water access. The household water
treatment methods are also used in SA and are mostly done when responding to the
water related disease outbreaks (DoH, 2009).
6.4 HOUSEHOLD WATER TREATMENT AND STORAGE ANALYSIS AND
RISK ASSESSMENT
Household Water Treatment and storage is regarded as the main strategy that can
be used to ensure sustainable use of safe water at household level (WHO, 2007).
159
The impact of managing water treatment and storage at household level has been
proven to reduce the disease burden in most of the trials conducted even though the
strategy resemble the biasness; if the strategy is supported by continuous education
the public health gains may be acquired (Hunter, 2009a). HWTS target was one of
the outcomes in the world forum indicating the need for commitment in policy
formulation by additional 30 countries in 2015 to promote safe water use by
employing various treatment methods and storage (WHO/UNICEF, 2012).
In the context of household water management, Sobsey (2007) indicates as
illustrated in Figure 6.1 the importance of using WSP in the household during water
collection, treatment and storage in order to address water quality from the source,
water collection, water treatment, water storage and water use. In order to
accomplish the surveillance, monitoring and management of safe water as part of
household risk assessment in terms of water quantity and water quality of the entire
area is of vital importance as shown in Table 6.1. The minimal access and
availability of water is usually associated with poor hygiene and diarrhoea
prevalence. The determination of risks in an area is usually determined by the
accessibility, availability and water quality as outlined in Chapters 2 and 4 of this
study. Hence, water which is not accessible and available, obscures implementation
of WSP.
The situation could be of more challenge when the households had to find drinking
water somewhere or in unprotected sources other than from the one obtained from
protected sources provided by the WSA. The location in which water used for
drinking plays a crucial role in water safety management. Where community access
160
water from different sources, it becomes so much difficult to determine the way in
which risks could be identified.
Figure 6. 1: Illustrated critical control points for household water Surveillance, Monitoring and Management
The implementation of monitoring and evaluation in terms of what is prevailing in the
particular community and the treatment method used at household level could make
it easier to measure the risk level (WHO, 2012). Evaluating the critical points of
household water management could have influence on the health of the human
being at household level. It is of vital importance to determine the risk score in terms
of water quantity (availability), accessibility (distance), water quality (potability) and
health risk impact (diarrhoea ) in PRH as prescribed by scoring risk matrix suggested
by WHO (2011) as shown in Table 6.1.
Water treatment
and Point of use
Water source
Household water
Management Storage Collection
161
The situation could be of more challenge when the households had to find drinking
water somewhere or in unprotected sources other than from the one obtained from
protected sources provided by the WSA. The location in which water used for
drinking is found plays a crucial role in water safety management. Where community
access water from different sources, it becomes so much difficult to determine the
way in which risks could be identified.
Table 6. 1: Scoring matrix of risks outlined by (WHO, 2011)
Likelihood Severity of Consequence
Insignificant Minor Moderate Major Catastrophic
Almost Certain 5 10 15 20 25
Likely 4 8 12 16 20
Moderately likely 3 6 9 12 15
Unlikely 2 4 6 8 10
Rare 1 2 3 4 15
The scoring risk matrix can be implemented effectively where risks in terms of
availability, accessibility, water quality and diarrhoea impact is known and quantified.
The purpose of risk matrix is to quantify hazards from the outcomes of household
survey as indicated in Table 6.1. In each quantified risk severity of consequences
were outlined in terms of insignificant, minor moderate, major and catastrophic which
represent the level of impact. The impact is measured against the severity to indicate
Risk score
<6 6-9 10-15 >15
Risk rating
Low Medium High Very high
162
the level of health risk rated from low, medium, high and very high. However the
quantified hazards and risks shown in Chapter 2 was adapted from the above risk
matrix. The risks were rated as no threat (no impact), tolerable (minimal health risk
that could cause harm to few), Peripheral (Can cause infections to vulnerable groups
who are immune compromised) and not tolerable (it should not happen as it can
cause health hazards).
The risks in terms of basic water accessibility and availability locally and
internationally as outlined in Table 2.1 could be used to assess the probability of
risks in terms of water safety. Tables 2.4 and 2.5 further suggest risk indicators that
could be used to assess the risk score based on Table 6.1. The public health impact
has been clarified in accordance with the measurement as indicated in Table 2.6 in
accordance to the water quality standard. Therefore accessibility, availability and
potability are represented in Figure 6.2 as the standards that could represent the
measurable service that should be rendered to PRH as the first step of WSP for
households.
163
Figure 6. 2: Assessment of risks on water service indicators and Health
164
The similarities between SA and international water service standard is that both of
them indicated the accessibility in terms of distance travelled and the round-up trip
travelled to bring the water to the household; the availability is indicated in terms of
the volume of water that need to be accessed per person per day. SA specified only
the basic standards which are more improved as compared to the international
standards. However indicators such as intermediate are indicated on the water
service regulatory strategy (DWA, 2010), while reliability of water service is not
indicated. The level of public health risks were also indicated to measure the impact
of the services rendered in an area, which can link well in terms risk score indicated
in Table 6.1.
To compare the public health risk with that of SA, the basic water service standard
was used to determine the public health risk even though is not mentioned in Water
and Sanitation policy White Paper (DWA, 1994). The standard in SA was set in
terms of basic water service which is used for provision of water in most of the PRH.
The microbial and physical water quality was discussed under the domestic safe
water management in Chapter 2 Table 2.2.
6.5 THE PROCESS OF THE HOUSEHOLD WATER SAFETY PLAN
6.6 Risk assessment of water service level indicators
Chapter 2 made analysis of the water service indicators as well as the level of
compliance in terms of water service rendered to each household.
165
Risks associated with water service indicators were also outlined. However,
literature revealed that most of WSA’s do not meet the required water service
standards. The outcomes of the study also support the findings outlined in Chapter
2. The study further indicated the discrepancy of reliable water supply within the
community serviced. The study clearly shows that when case study 1 was
conducted most of the communal taps were dry and some members of the
community collected water from the rivers and springs; whereas in case study 2 of
the study some villages depend on alternative water supply other than communal
water source. That was only based on the reliability of water source without
considering its safety. Findings indicated that communal water sources were better
in water quality than alternative sources. Communal taps were reported not to have
water up to a period of 6 months to a year in all villages.
The study indicate risks in terms of preliminary and onsite risk assessment, using
Hazard Analysis Critical Control Point (HACCP). This approach was adapted from
the concept of Hazard Analysis Critical Control Point (HACCP) regulated for food
industries since 1990’s (Codex Alimentarius 1997). The HACCP concept
recommended seven steps of which only four steps will be used for this study. The
steps include; involvement of a team, Analyses of hazards and hazards events,
Critical limits and risk control measures (WHO 1997).
Table 6.2 outline the hazards, critical limits and hazards events; while Table 6.3
indicate hazards events with and without control measures using the risk matrix and
risk scores. Table 6.2 systematically indicate procedures that need to be followed
166
when risk assessment is done. Preliminary assessment include water service
indicators based on DWA (1994) followed by onsite risk assessment indicating risk
assessment procedure at household level from the collection point to the point of
use. The information outlined were received from community leaders, WSA’s
representatives and households as outlined in Chapter 3. Table 6.2 and 6.3 is
informed by Figures 6.3 and 6.4 which are further discussed in Section 6.5.2.
167
Table 6. 2: Preliminary and onsite Hazard analysis of household drinking water, adapted from Pérez-Vidal et al., (2013)
Risk
analysis
criteria
Activity and
procedure of risk
assessment
Hazard event Critical Limits Type of hazard
(DWA 1994) Water
Quantity
Water
Quality
Hygiene
Structural
Design
Pre-requisite
hazard
analysis
1. Accessibility -Distance travelled to improved water source less than
200m
-Unimproved water sources closer to households and the furthest distance of more than 5km
- Distance travelled
to the source should
not exceed 200m
X X
2. Availability -Communal water sources not available for up to 6 months to a year
- Unimproved water sources used as alternative source
and are reliable.
-25ℓ/c/d water should be available
to each person.
X
X
X
X
X
3. potability -Contaminated communal water source used for
consumption
-Contaminated alternative sources used for
consumption
-The use of unimproved sources
-Use of contaminated water stored in containers
-Private boreholes located next to sanitary facilities
(septic tanks, cow shed, toilets etc.)
-Private boreholes connected to a dirty tanks
-Total coliform
counts should not exceed 10/100mℓ
-E. coli and
enterococci should not be found in
water (0/100mℓ)
X
X
X
X
X
X
X
X
X
X
X
X
X
X
On-site risk
assessment
from
collection
point to the
point of use
4. Collection point -Dirty containers used for water collection (showing
scratches, biofilm and moving particles)
-Hands dipped inside drinking water during collection.
Not determined X
X
X
X
X
X
5. Transportation -Dirty wheel barrow load used for water transportation
-Water transported in dirty container without lid in
dusty roads
-Water transported by head with hands dipped inside
Not determined X
X
X
X
X
X
X
X
X
6. Storage -Water stored in dirty containers
-water stored in container without the lid exposed to
dust
-Water stored in dusty house
Not determined X
X
X
X
X
X
X
X
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Table 6. 3: Risk assessment matrix in household water Adapted from Pérez-Vidal et al., (2013)
Activity and risk
assessment №
Risk estimation without control
measure
Corrective measures Risk estimation with control measure
Hazard № Consequence Risk Consequence
Risk
1. Accessibility
Major impact
with serious
health
consequence
Not tolerable -Provision of safe water to
reduce distance, prolonged
waiting time and use of
unimproved water sources.
Marginal impact
which can cause health
risk
Peripheral (3)
2.Availability
and potability
Major impact
with serious
health
consequence
Not tolerable -Disinfection of water
obtained from unsafe sources
- Health education and
awareness
Marginal impact
which can cause health
risk
Peripheral (3)
3. Potability
Major impact
with serious
health
consequence
Not tolerable
-Health education on good
water storage and hygiene
practice at home
-Conduct environmental
impact assessment before
construction of sanitary or
water system
Major impact with
serious health
consequence
Not tolerable (4)
4.Collection
point
Major impact
with serious
health
consequence
Peripheral
Health education on good
water storage, hygiene and
treatment
Minimal impact
causing dissatisfaction
and health concern
Tolerable (2)
5.Transportation Major impact
with serious
health
consequence
Peripheral
-Clean and disinfect transport
used for transporting water
-Health education and
awareness on hygiene
practices at home
Minimal impact
causing dissatisfaction
and health concern
Tolerable (2)
6. Storage Major impact
with serious
health
consequence
Not tolerable -Health education on good
water storage, hygiene and
treatment
Minimal impact
causing dissatisfaction
and health concern
Tolerable (2)
7 Point of use Marginal
impact which
can cause
health risk
Peripheral -Health education and
awareness on good hygiene
practices at the point of use
Minimal impact
causing dissatisfaction
and health concern
Tolerable (2)
169
6.7 Risk assessment of household water
Figure 6.3 suggests the process that could be followed to assess factors that could
cause risks in drinking water used at household level. Relative to this risks
assessment criteria, the starting point of risk control should be at the tap or source
as outlined in Figure 6.1. The fundamental criteria is to assess the water quality,
followed by risk assessment at the source that could render such water to be unsafe
as outlined. In case study 2 risk assessment that could lead to water contamination
was observed; as outlined in the questionnaire in appendices 2. Such observations
included the type of water sources used, condition of collection containers, place
where water is stored and availability of sanitary facilities. The risks of water
contamination in the household will be supported by the outcomes of water quality
assessment. The scores are then benchmarked with the risk scores and intervention
done based on the findings that indicate the area of risks at household level as
outlined in Table 6.2.
The outcome of household water service level and risk assessment of household
water will form the Framework of household water safety plan as indicated in Figure
6.4. The household water safety plan will depend on the preliminary factors and
risks of water service level within the household as outlined in Table 6.3. The water
quality outcomes will support the findings of these risk assessments. It is the
responsibility for WSA’s to give satisfactory service to the community that entails
water that is reliable, safe, affordable and accessible.
170
Figure 6. 3: Assessment of risks in household drinking water
Ob
se
rva
tio
n
ASSESSMENT OF HOUSEHOLD WATER SAFETY RISKS
Determination of Household
risks
Water quality status
Animals Around water sources
Refuse disposed around water sources
Stagnant wastewater
Human activities-waste disposal
Vectors visible
Technology used
Faulty taps Hands contacts
Water sources
Hands contacts
Types of container used
Environmental condition (dust)
Container hygiene
Open or closed container during transportation
Mode of transport
Rest period
Time spent before home
Mode of transport Condition of transport
Structure of storage facility (light, ventilation, building structure
Hygiene of storage facilities
Location of water storage facilities (inside or outside)
Type of storage container used
Hands contacts in decanting
Hygiene of container
Open or closed container
Environmental conditions
Hands contact when decanting
Condition and hygiene of scooping vessel
water use e.g. drinking, bathing, laundry, other domestic chore or everything
Storage and point of use
Average Risk Level Risk level 2 Risk level 3 Risk level 3
Score
Score
Score Score
Ob
se
rva
tio
n
Ob
se
rva
tio
n
Collection and Transportation
171
Figure 6. 4: Household water safety frame work adapted from WHO, 2011
HOUSEHOLD WATER SAFETY FRAMEWORK
Village water service level assessment Health based targets Assessment of household water risk assessment
Conduct hazard analysis
Set control limit
Describe control measures
Number of acute
diarrhoea recorded in
health facility
Critical control point
Tap source Collection and
transportation Storage Point of use
Conduct hazard analysis
Supportive program Surveillance and control
Education (Intervention measurements)
Responsibility
NGO, consumers, Local authority, stakeholders Water service Authority
Water Safety Plan
172
Risk management at the household level will require a team effort that includes the
household owner; Community based organizations, Non-Governmental Organizations
(NGO’s), Public health officers and Health Promoters. Both WSA’s and stakeholders
should provide continuous education on best hygiene practices to prevent
contamination of water that could lead to diarrhoea or acute infections.
The team that was included for the study included the Water service authority that
include water managers operators and Environmental Health Practitioners who gave the
status of water in villages where study was done. The information was also obtained
from the Village leaders that include councillors and traditional leaders. In depth study
and risks associated with drinking water was obtained from the household where survey
was conducted. Water quality status at POU will be the measurable impact of water
service level and household risks ad indicated in Table 6.3 and the control measures
that could minimize risks in drinking water. Once the scores are determined and risk
level is measured, household water safety plan can be initiated.
6.8 Household water safety plans
Household WSP (Figure 6.5) is the assessment of risks from the collection point
(source) to the POU. The plan will always be informed by the household water safety
framework in Figure 6.4. The outcomes of the framework will determine the way in
which household WSP should be assessed. The Assessment of household WSP
focuses on system control which is the water sources and water service level indicator’s
assessment that include accessibility, availability and potability as well as storage and
POU. The assessment of systems should be informed by outcomes of hazard analysis
173
(Table 6.2) that will lead to monitoring of water in terms of domestic water practices and
quality. The outcomes will indicate the areas where the community need to be
educated, measures taken for control as outlined (Table 6.4).
6.9 SYSTEMETIC APPROACH OF HOUSEHOLD WSP IN RURAL HOUSEHOLDS
6.10 Prerequisite assessment and formulation of a team
Understanding the state of water service and its risk before application of WSP is
crucial. This step can only be achieved by formulation of a team that understand the
water services in the area. In rural setting team members will include traditional
leaders, household members, councillors, water operators and Environmental Health
Practitioners or heath promoters if available as well as NGO’s that are somehow
affected or deal with water services. This could differ from one area to the other. The
type of water sources used (improved or unimproved sources), distance travelled to
access water, volume of water and its reliability as well as level of sanitation, could play
a critical role in determining hazards during HACCP implementation. HACCP
recommend the use of pre-requisite application as a baseline in identifying hazards
(Mortimore 2000). It is the first point that aims at preventing hazards and to take note of
precautionary measures where system could fail (Swierc et al., 2005). In rural setting
this simply mean to assess the water sources used its reliability and distance travelled
to the sources. Hazard analysis and identification of hazard events is crucial and
determination of volume of water that accessed by each member of the household
using 2.1 equation as outlined in Chapter2. This step form part of risk assessment
174
procedure as outlined in Table 6.2. This step is followed by the on-site risk assessment
of drinking water used and hygiene practices in households which start from collection,
transportation, storage and point of use.
6.11 On-site risk assessment
On-site risk assessment is the second step in risk assessment. It is the information that
can be adequately provided by those who collect and use water on daily basis. The
study indicated that majority of women are the one responsible for water collection,
transportation, determining how and where water should be stored and used. Onsite
risk assessment starts at the collection point where one should determine if the water
source is improved or unimproved source. The container used to collect water and its
hygiene is very crucial. The transport used need to be recorded including its risks. If
Wheel barrow is used to transport water to a household and is dirty, that can have
impact on hygiene and water quality. Container used to store water can also pose
health risks as outlined in Chapters 5 and 4. Its structural design in terms of narrow and
wide opening as well as easier to clean or not determine the risk of drinking water at the
point of use. The procedure indicated in Table 6.2 on hazard analysis is crucial in
determining the critical control point as indicated in the risk procedure.
175
6.12 Hazard analysis and control measures
Risk assessment and analysis of hazard using the Critical control points outlined as risk
procedures in Table 6.2 and 6.3 could assist in outlining the risks in each step. Where
critical limits are available, could assist in risks score and rating. This is one of the
important step where each risk should be mapped and identified depending on the
nature of the setting. Table 6.4 and 6.5 indicate step by step checklist on how to
conduct Household WSP in typical rural areas with limited resources. The summarized
WSP procedure should be used in conjunction with risk matrix as outlined in Table 6.2.
Education is very crucial to ensure the team could show other members how hazards
can be identified and controlled. Maintaining of records is very crucial hence; frequent
communication is essential.
6.13 Simplified Household WSP for rural household
Figure 6.6 outline the procedure used to establish WSP as proposed by WHO (2005).
The only gap in this method is that establishment of a team is usually at the onsite
assessment whereas the simplified method outlined in Table 6.4 indicate Assemble of
team as a prerequisite measure that should be done at initial stage. In rural areas with
limited facility, only water operators and interested stakeholders of the community that
could take decision and community health worker who understand risk brought by
unsafe water is required. The purpose of the team will be to evaluate the type of
service provided by the authorities and make recommendations as well as to seek the
176
advice from the professionals so that they could understand the QMR of water within
the community.
Identification of infrastructure available and level of sanitation at the household could
establish risk matrix of the household members in drinking water. The checklist can
assist the Community health worker on the appropriate health education that need to be
provided. Using prerequisite assessment assist in identifying hazards that could
impede the implementation of household WSP. Table 6.5 suggest that household WSP
should start at the source where water is collected followed by transportation, storage
and point of use. Good analysis or flow of events assist in determining how safe water
can become unsafe for use. The establishment of whether the user understand when it
is appropriate to use water treatment is very important. When the community able to
understand the need for water treatment it symbolise the health literacy and that means
less risk to community. It is the duty for the government to close the gap where health
literacy is lacking through establishment of policies that can support such initiatives as
shown in Figure 6.6.
177
Figure 6. 5: Schematic diagram of Household water safety plan adapted from WHO (2005)
HOUSEHOLD WATER SAFETY PLAN
SYSTEM ASSESSMENT MONITORING
Monitoring of household risks
Choose relevant intervention
Communicate with relevant stakeholders
Development control measures
Monitor and evaluate household water and storage
Provide support system (training, and research )
Domestic water practices
Water quality assessment Hazard analysis
Water source
Collection &
transportation
Storage
Point of use
MANAGEMENT AND COMMUNICATION
178
Table 6. 4: Checklist for Household WSP- Pre-requisite assessment-
Assemble a team Yes No
Water Service
Water Access Distance < 200m Yes No
Availability
25ℓ/c/d available to each person Yes No
Improved water source used Yes No
Potability
No odour or foreign objects
visible
Yes No
Established tolerable water
quality that cannot cause
infection
Yes No
Household
Sanitation
Toilet available (adequate
faecal disposal system)
Yes No
Hand washing facility with soap
at the toilet
Yes No
Good wastewater and solid
waste disposal
Yes No
Safe keeping of animals Yes No
No flies or rodents visible Yes No
179
Table 6. 5: Checklist for household drinking water-onsite assessment
Household drinking water Yes No
Type of source
Improved potable water source
Unimproved water source
Collection
Use container to store water
Use container with lid
Use container without lid
Use dirty container with biofilm or scratches or foreign
objects
Transportation Use dirty Wheelbarrow or cart or vehicle
Storage
Hands contact during transportation
Water stored outside
Water transferred to dirty container without lid
Water kept in dirty dusty house
Water can be accessed by children or animals
Point of use Dirty scooping vessel is used
Household water
treatment and education
Know when is appropriate for household water treatment
to be done.
Hands contact during water scooping
180
Figure 6.6 suggest that policy addressing safe water management should be addressed
by water service indicators, household water safety framework, environmental health
practices related to water safety and household water safety plan as outlined in Figure
6.2 to 6.5. Following the above protocol will ensure safety measures are in place to
ensure potable water to the community up to the point of use.
Figure 6. 6: Policy framework of domestic safe water management
6.14 SUMMARY
Household WSP is the first step of ensuring safe water and prevention of acute
diseases at the household level. It is vital for WSA’s to inform the community about the
risks status of drinking water in terms of availability, accessibility and potability prior to
implementation of WSP at the household level. The WSP is the recommended way that
is used to detect risks at an early stage, it is therefore crucial to adopt early detection at
POLICY
Household water safety framework
Household water
practices
Household Water Safety Plans
Basic household
water Service Level
181
the household level. Identification of risks through hazard identification and
strengthening the household water storage and treatment is essential. A household
water safety plan is a key issue that should be addressed in policy for public health
gain.
182
CHAPTER 7: CONCLUSION AND RECOMMENDATIONS
7.1 INTRODUCTION
Chapter 7 summarizes the outcomes of the case studies and sets out how they support
the need for Household WSP. It further outlines the extent to which the aims and the
objectives, as well as the research question of the study were achieved. Contributions
of the study to new knowledge based on the household water safety management
outcomes in rural households were also outlined. The limitations, recommendations
and further studies are included in this chapter.
7.1.1 Desktop study Review
Objective 1: To review and to make comparison on the current situation on basic
water service level internationally and in SA associated with household water
management
To achieve the above objective, the literature review on basic water service level
indicators was conducted to compare what was prevailing internationally and in South
Africa. The review was based on the basic level of service and indicators that are used
to measure basic water level internationally and in South Africa. The Chapter answer
the question; “What are the policy implications on basic water service level in
rural households of South Africa as compared to international water service
standard indicators”?
183
Basic water level indicators in South Africa were based on the Water and Sanitation
Policy White Paper of 1994; while the international indicators were based on WHO
standard that are currently used in most of the developing countries as outlined in
Chapter 2. The key concepts that were outlined include availability, Accessibility and
Potability of water. Each indicator was critically benchmarked and a risk score outlined.
The standard that outlines the water service internationally indicated each household
member to have access to 20ℓ volume of safe water at a distance of 1000m within 30
minutes. SA policy requires each person to have access to 25ℓ within 200m distance
and the water should be available for 24hrs. However, the following are the policy
implications related to household water safety management:
Internationally, the benchmark indicator did not include the type of route used, the
queuing time, and the type of technology used;
In SA, 200m was based on one-way trip and no queuing time indicated, time that is
needed to collect and bring water at home as well as the type of route used;
Indicators in SA are better as compared to the international benchmark;
Despite good indicators there was no methodology used by WSA’S to assess its
compliance;
Estimate methodology that could be used by WSA’s to access its water service
level in rural areas was developed and outlined in chapter 2;
Thus, when compared these local and international standards it shows that in SA
there is no gap on water quality standards that are used locally and internationally;
However, in general the following have been observed so far in this study through
literature reviewed and field work that;
Developing countries including SA are still faced with shortage of water and do not
comply with the indicators benchmarks as outlined;
184
Household Water Safety management is not usually practiced in rural
households of South Africa and
Water and Sanitation policy need to be reviewed in terms of these indicators.
7.1.2 Case study 1
Objective 2: To determine basic level of household water management practices
following an outbreak of cholera in rural areas of Limpopo province.
To conform to the objective 2, Case studies 1 on basic level of domestic water
management follow up after an outbreak of cholera in deep rural area of Limpopo
Province. (Deep rural domestic water management case study). Case study 1 was
conducted in eight rural villages of Limpopo Province following an outbreak of cholera.
A follow-up was done seven months after an outbreak of cholera to determine the
household water management practices; specifically looking at the type of sources used
and its accessibility, availability, water treatment and health education. The case study
was answering the question “To what extent does cholera outbreak changes the
way in which rural communities manage their household water”?
The following were the outcomes:
Households used boreholes, communal standpipes, river and springs water
sources;
Water was not usually available in communal sources and majority of communities;
use rivers and springs as their alternative or secondary drinking water sources;
Containers that were used to collect and store water were dirty presenting biofilm
and excessive scratches;
185
only 18% of the households treat their water and the rest of the households who
participated in the study confirmed not treating their water;
Most of the households confirmed that they received health education during the
cholera outbreak and no further health education was given thereafter and
Despite health education given during the cholera outbreak, the outcomes of this
case study confirmed that the majority of the households did not practice household
water safety management.
7.1.3 Case study 2
Objective 3: To scrutinise households on domestic water quality and practices
A household survey on domestic water practices was conducted at Sithumule and
Tshifhire rural villages of Limpopo province case study 2. (Rural peri-urban domestic
water management case study
Two questions asked for case study 2 were “What are the current household water
services and practices in peri-urban areas of South Africa”; as well as
What is the status of drinking water quality used in households”?
Sinthumule villages was selected based on the high scarcity of water from communal
taps and availability of private wells that were used more often when water is not
available. Tshifhire village is one of the few villages with small water treatment plant
and number of springs that were regularly used when water from the taps was not
available. A survey was conducted in 201 households scrutinising domestic water
practices. The survey included type of water used, availability, accessibility and
potability. Water quality analysis was done from 240 water samples taken from the
186
sources and containers used for storing water in the households. Physical (Turbidity, pH
and Electrical conductivity) and microbiological analyses (total Coliform, E. coli and
enterococci) were performed. Generally the following key outcomes were found on the
household survey that answers the above questions:
Sources: All villages used communal standpipes as their primary water source and the
difference was that at Sinthumule village communal sources were supplied by the
boreholes while at Tshifhire water is a supplied by a water treatment facility from the
catchment dam. Communities at Sinthumule use private wells more often as their
secondary source whereas tanker truck sometimes deliver water occasionally to the
village when water is not available. Tshifhire village had yard taps from communal
facility and used spring water as their secondary or alternative source. No yard
connection from communal facility was found at Sinthumule village. Yard standpipes
and private drilled well were mostly found in households with individuals who had more
than 6 in the household, tertiary level or some form of vocational training and earn more
than R2000 a month as indicated in Table 4.5.
Access: Communal standpipes, yard standpipes, private wells and tanker trucks were
often within a distance of 200m as outlined in the studies. Spring water was located at
a distance of more than 200m. The households reported that they waited at the
communal water sources for 10-60 minutes before they can get a chance to collect
water. The households at Sinthumule pay an average of R13 a day to obtain water
from those who own private wells when they need water in the house; particularly during
those times when water is not available. The availability of water in communal source
was the same in all the households regardless of socio economic status as outlined in
Appendix E.
187
Availability: It took up to 6 months to a year without water in communal taps. The most
reliable sources that always have water were springs and private drilled wells.
Containers water: To temporarily limit the shortage of water in the households,
containers were used to collect and store water. Narrow and wide opening containers
were used with or without lids.
Condition of the container and rooms where they are kept: Some of the containers
were found dirty with excessive scratches, biofilm and with loose particles inside.
Environmental hygiene was also the same in all individuals regardless of socioeconomic
status as outlined in appendix G.
Household water treatment: Majority of the households do not treat their water.
Potability (water quality): pH level of all water samples met the required standard
whereas turbidity was high in spring water and Electrical conductivity high in private
drilled wells. Total coliforms, E.coli and enterococci were found in all sources. The
prevalence of E. coli was lower as compared to enterococci. Most contaminated water
sources were springs, tanks and private drilled well whereas communal sources were
least contaminated. Microbiological counts in containers stored water were higher as
compared to the level of contamination in water sources. High contamination of
container water could indicate poor domestic safe water practices and management.
Reliability: The study indicated that the most reliable sources in terms of water
availability were the most contaminated once. These water sources were regularly
used when there was no water available in communal sources.
188
7.1.4 Household Water Safety Plan
Objective 4: To develop household water safety plan (Domestic safe water plan)
The analysis of risk from the tap to the POU was done based on the outcomes of the
study. A step by step process of Household WSP was outlined in chapter 6. The
outcomes of the study were based on these questions “What are the steps followed to
develop household WSP and how does household WSP inform drinking water
policy”? The following were the findings that answer the above question:
An overview of household WSP was outlined indicating the risks that could be
incurred from tap (water service level), collection, storage and POU;
A process of risk assessment was illustrated by self-assessment of village water
service level (Figure 6.2), household risk assessment (Figure 6.3), household
water safety framework (Figure 6.3) and household WSP (Figure 6.5).
Reliability of water service and education was identified as the key issue in
household WSP;
Identification of key role players and allocation of responsibility is also important;
Diarrhoea statistic and water quality outcomes from health facilities could indicate
the impact of poor household water safety management and
The household water policy addressing the key processes on household WSP is
important to increase public health gains.
The above secondary questions answers the primary questions on “How best can
we address the household water safety management in PRH through policy?
189
7.2 CONCLUSION
The study concludes that water safety management is not practised at the household
level. Villages affected by the cholera outbreak were experiencing water scarcity and
those that have access to multi sources were all at risk of contracting acute infections.
All villages were using communal taps found on the street as their primary water source.
The challenge was that the sources were not reliable and always without water. Most of
the villages were reliant on alternative water sources other than primary sources. A
review on basic water service level indicated a lack of compliance with WSA’s standard
outlined by the SA government on basic water service delivery. Lack of sustainability to
access basic water service was a major challenge locally and internationally.
Benchmarks attached to indicator’s standard revealed some gaps. However, there was
no methodology that could be used by WSA’s to assess themselves based on the basic
water service level indicator’s standards.
There was limited indications of domestic water management issues in SA water related
regulations and policies. The two case studies indicate the multifaceted picture on
domestic water practices at the household level. All the outcomes reflected poor
hygiene and safe water management that could result into health risks in the
households. The study indicated that communities in the study area were not safe.
Distances travelled to alternative sources were far except for those who had the option
of using wells. The household water quality was also a main concern as higher bacteria
counts of E.coli and enterococci microorganisms were found in both communal and
190
alternative sources to the POU. The majority of households did not take measures
taken to control risks.
Factors such as once off water education after the cholera outbreak, use of unsafe
sources, poor hygiene, none treatment of water and poor water quality at the source as
well as at the point of use were some of the challenges that reflected risks that could
affect the household members. The above outcomes suggest the need to develop
household water safety plan that could be used in risk assessment at household level to
reduce the impact of acute infectious conditions that could affect the communities.
Such plans can only be effective if supported by a policy instrument. The study
suggests that there should be household policies that addresses domestic safe water
management through the household WSP.
7.3 STRENGTH AND WEAKNESSES OF THE STUDY
There were strength and weaknesses observed in this studies. The strength of the
study was that multiple methods were used to determine the status of households’
water safety management practices. This is shown in case study one and case study 2
as outlined in Chapter 3 and 4. To come up with household WSP different
measurements were outlined to support the outcomes of the study. The measurements
were delineated in Chapter 2 and 6. Chapter 2 indicated the equations and
measurements that could be used to determine water service level in a localized
community. Hence, Chapter 6 outlined where and how such measurements could be
used to come up with Household water safety framework and household WSP.
191
Through these measurements, the study clearly indicated that determination of water
service level prior to implementation of household WSP is important, it could assist in
speculating the risks within the households.
The weakness was that, the study was conducted in one geographical area; but
different methodologies were used to come up with valuable research outcomes that
could be beneficial in public health. The study did not look at the personal practices
relating to culture that could have major influence on the way in which water is managed
at home. Household WSP suggested by study cuts across every culture. If used as
suggested, it will lead to the same results.
7.4 RECOMMENDATIONS
A household water safety plan should be addressed through water policy;
There is a need for water and sanitation policy review based on basic water service
level indicators to address issues relevant to current and future water service
delivery;
More studies on water indicators and distances travelled to water sources are vital in
accessing the risks related to domestic safe water management;
Intestinal enterococci have been observed to survive for longer in adverse aquatic
environments than E. coli and their survival pattern may correlate more closely with
those of several waterborne pathogens;
192
Blue Drop assessment should include water reliability for each municipality
assessed;
Immune-compromised individuals should know public health impact pertaining to
risks in water;
Household water quality guide and safe water management need to be developed
and
Household water safety plan and risk assessment should be practiced at household
level to empower communities to manage their own health.
7.5 FUTURE RESEARCH STUDIES
There is a need for testing self-assessment risk methodology proposed for WSA’s
to measure water service level;
Intervention research on water sustainability is needed;
Further study on the feasibility on implementation of Water safety plan at household
level is essential;
Both national and international indicator’s standard benchmarks need to be
assessed thoroughly and its consequences in terms of risks;
Cultural and personal practices affecting household water safety management in
poor and rural households;
More research needs to be undertaken to determine the survival and distribution of
intestinal enterococci in household water and
193
Research based on risk scores at household level is essential and Communication
of health risks to communities and sector involvement in terms of water safety
management in households.
194
REFERENCES
AFRICAN NATIONAL CONGRESS. 1994. African National Congress Reconstruction and
Development programme. A Policy Framework. Johannesburg: Umanyano Publications: pp 4-
10.
ANDRES, L. 2012. Designing and doing survey research. Sage Publishing LTD, 1st
edition. London: 31-89.
ARAIN, M., CAMPBELL M.J., COOPER C.L. & LANCASTER, G..A. 2010. What is a
pilot or feasibility study? A review of current practice and editorial policy BioMed
Central: Medical Research Methodology 2010, 10 (67): pp 1-7.
ARKU, F. S. 2010. Time savings from easy access to clean water Implications for rural
men’s and women’s well-being. Progress in Development Studies: 10 (3): pp 233-246.
ARMSTRONG, P., LEKEZWA, B. & SIEBRITS, K. 2008. Poverty in South Africa: A
profile based on recent household surveys. Matieland: Stellenbosch Economic Working
Paper: pp 1-20 [online]. Available from: www.uni-goettingen.de/de/document/...pdf/wp-
04-2008%5B1%5D.pdf. [Accessed 20/02/2013].
ARNOLD, D.M., BURNS, K.E., ADHIKARI, N.K., KHO, M.E., MEADE, M.O. &
COOK, D.J. 2009. McMaster Critical Care Interest Group. The design and
195
interpretation of pilot trials in clinical research in critical care.Crit Care Med 2009,
37 (1): pp 69-74. PubMed Abstract.
AROUNA, A. & DABBERT, S. 2010. Determinants of domestic water use by rural
households without access to private improved water sources in Benin: a seemingly
unrelated tobit approach. Water resources management, 24: pp1381-1398.
ATEBA, N.C & MARIBENG, D.M. 2011. Detection of Enterococcus species in
groundwater from rural communities in the Mmbatho area, South Africa: risk analysis.
African journal of Microbiology research, 5(23):3930-3935.
ATUSINGUZA, F. & EGBUNA C.K. 2012. A microbiological risk assessment of a
private water supply in Southeast England: Implication for future policy. Journal of Life
Science and Biomedicine, 3(1):40-51.
BETANCOURT, W. Q. &. ROSE J. B. 2004. Drinking water treatment processes for
removal of Cryptosporidium and Giardia. Veterinary Parasitology, 126 : 219–234
BEUMER, R., BLOEMFIELD, S.F., EXNER, M., FARA, G.M., SCOTT, E. & NATA, J.K.
2002. Guideline for prevention of infection in the domestic environment. Intramed
communications, Milan: 5-6.
196
BOONE, C., GLICK, P. & SAHN, D. 2011. Household water supply choice and time
allocated to water collection: Evidence from Madagascar. Journal of Development
Studies, 47:1826-1850.
BRADLEY, D. J. & BARTRAM, D. K. 2013. Domestic water and sanitation as water
security: monitoring, concepts and strategy. Philosophical Transactions of the Royal
Society A: Mathematical, Physical and Engineering Sciences, 371(2002): 20120420.
BROWN, J. M., PROUM, S. & SOBSEY, M.D. 2008. Escherichia coli in household
drinking water and diarrheal disease risk: evidence from Cambodia. Water Science and
Technology, 58 (7):1-7.
CENTER FOR SCIENCE AND INDUSTRIAL RESEARCH(CSIR). 2009. Diarrhoea,
Third biggest killer in South Africa. Science scope Magazine. Research for improved
health. Pretoria, South Africa: 21.
CLASEN, T. 2010. Household water treatment and the mellennium development
goals: keeping the focus on health. Environmental Science and Technology: 44
(19):7357–7360.
197
CLASEN, T.F. 2009. Household Water Treatment in Poor Populations: Is There
Enough Evidence for Scaling up Now? Environmental Science and Technology, 43
(4):986–99.
CLASEN T, R. I., RABIE T, SCHMIDT, W. & CAIRNCROSS, S. 2007. Interventions to
improve water quality for preventing diarrhoea (Review). Evid.-Based Child Health, 2:
226–329.
CLASEN, T. 2006. Household water treatment and safe storage:research and
implementation. London School of Hygiene & Tropical Medicine,10 [ONLINE]. Available
from: http://www.who.int/household_water/resources/4WWF_clasen_research.pdf.
[Accessed 20/07/ 2009].
CODEX ALIMENTARIUS. 1997. General principles of food hygiene. CAC/RCP 1-1969,
1-31.WHO, Genever [ONLINE] Available from: http://www.codexalimentarius.org/down
load/standard/CXP_001E pdf. [Accessed 20/06/2014].
COLFORD, M.J., SCHIFF, K.C., GRIFFITH, J.F., YAU, V., ARNOLD, B.F., WRIGHT,
C.C., GRUBER, J.S., WADE, T.J., BURNS, S., HAYES, J., MCGEE, C., GOLD, M.,
CAO, Y., NOBLE. R.J., HAUGLAND, R. & WEISBERG, S. 2012. Using rapid indicators
for enterococcus to assess the risk of illness after exposure to urban runoff
contaminated marine water. ScieVerse Science Direct, Water research, 46: 2176-2186.
198
CROW, B., DAVIES, J., PATERSON, S. & MILES, J. 2013. Using GPS and recall to
understand water collection in Kenyan informal settlements. Water International,
38(1):43-60.
DANERT, K. & HARVEY, P., 2009. Myths of the rural water supply sector. Rural Water
and Sanitation Network, pespective 4:1-7 [ONLINE]. Available from: www.rural-water-
supply.net/en/resources/details/226 . [Accessed 23 June 2011].
DAR, O. A. & KHAN, M. S. 2011. Millennium development goals and the water target:
details, definitions and debate. Tropical Medicine & International Health,16(5):540-544.
DAVIS, J., CROW, B. & MILES, J. 2013. Measuring water collection times in Kenyan
informal settlements. Proceedings of the Fifth International Conference on Information
and Communication Technologies and Development. Water international 38(1):43-60.
DAVISON, A., HOWARD, G., STEVENS, M., CALLAN, P., FEWTRELL, L., DEERE, D.
& BARTRAM, J. 2005. Water safety plans, Geneva, WHO [online] 3-34. Available from:
www.who.int/water_sanitation_health/dwq/manual.pdf. [Accessed 23/03/2010].
199
DE CONING, C. & SHERWILL, T. 2004. An assessment of the water policy process in
South Africa (1994 to 2003). Pretoria, South Africa: Water Research Commission
Pretoria:1-4.
DE FRANCE, J., DRURY, D., GORDON, B., HEATON, P., HEIJNEN, H., MERCER, J.,
SCHMO, L.O. & TUITE, S. 2012. Water Safety Planning for Small Community Water
Supplies: Step-by-step risk management guidance for drinking-water supplies in small
communities. Prepared for WHO, Geneva, Switzerland: 1-66.
DEPARTMENT OF HEALTH. 2008. Statement by the Minister of Health Barbara Hogan
on the outbreak of cholera in Zimbabwe and South Africa: pp 1-2 Media Room [online].
Available from: www.academia.edu/.../Leaving_behind_a_twisted_soul_the_2008-2009_
cholera_outbreak_in_South_Africa. [Accessed on 18 July 2009].
DEPARTMENT OF WATER AFFAIRS. 2012. Blue Drop Report 2012: South Africa
Drinking Water Quality Management and performance. Pretoria, South Africa.
DEPARTMENT OF WATER AFFAIRS. 2011. Blue Drop Report 2011: South Africa
Drinking Water Quality Management Performance. Pretoria, South Africa:1-26.
200
DEPARTMENT OF WATER AFFAIRS. 2010a. Department of Water Affairs Annual
Report 2009/2010; pp 22-34. Pretoria, South Africa.
DEPARTMENT OF WATER AFFAIRS. 2010b. Blue Drop Report 2010: South Africa
Drinking Water Quality Management and Performance :1-34 Pretoria, South Africa.
DEPARTMENT OF WATER AFFAIRS. 2010c. National water services regulation
strategy:10-56 [Online]. Available from: Available from:
https://www.dwaf.gov.za/dir_ws/dwqr/subscr/ViewComDoc.asp? [Accessed 20/06/2011].
DEPARTMENT OF WATER AFFAIRS. 2009a. Drinking water quality framework of
South Africa: Minimum requirements for Blue Drop Certification. Pretoria, South Africa:
Department of Water and Environmental Affairs: pp 1.24.
DEPARTMENT OF WATER AFFAIRS. 2009b. Media release: Water Affairs and
Forestry minister visited Limpopo, Pretoria, South Africa:1-2 [online]. Available from:
https://www.dwa.gov.za/.../MinisterHendricksVisitsLimpopo- Cholera12March2009.pdf.
Accessed [20/07/2009].
201
DEPARTMENT OF WATER AFFAIRS AND FORESTRY. 2007. Acceleration of water
and sanitation servicers delivery to meet the targets. In: DWAF (ed.):1-18 [online].
Available from: www.pmg.org.za/docs/2007/070221aowss.doc. [Accessed 20/07/2009].
DEPARTMENT OF WATER AFFAIRS. 2002. Free Basic Water Implementation
GuidelinesFree Basic Water Implementation Strategy: pp 1-20 [online]. Available from:
https://www.dwaf.gov.za/.../FBWLocalAuthGuidelinesAug2002.pdf [Accessed 20/ 06/
2009].
DEPARTMENT OF WATER AFFAIRS. 2001. South Africa water quality guidelines, 2nd
edition 1: 41-96. Pretoria. South Africa.
DEPARTMENT OF WATER AFFAIRS. 1994. Water supply and sanitation policy:1-20
[online]. Available from: http://www.dwaf.gov.za/Documents/Policies/WSSP.pdf
[Accessed: 05/12/2002].
DE VOS A.S., STRYDOM H., FOUCHE C.B. & DELPORTS C.S.L. 2008. Research at
grassroots for social sciences and human service professions: 47-49. ISBN
970627036126.
202
DU PREEZ, M., STEWART, A.C., POTGIETER, N. & VENTER, S.N. 2008. The use of
AFLP to determine the specific origin of Enterococci in drinking water in rural
households. Report to water research commission. WRC Report No 1602/1/08:1-22.
ENVIRONMENTAL PROTECTION AGENCY. 2008. Water Monitoring and
Assessment:1-5 [ONLINE]. Available from:http://water.epa.govt/type/rsl/monitoring/
vms55.cfm. [Accessed 20/06/2009].
EVANS, B., BARTRAM, J., HUNTER, P., RHODERICK WILLIAMS, A., GEERE, J.,
MAJURU, B., BATES, L., FISHER, M., OVERBO, A. & SCHMIDT, W.P. 2013. Public
Health and Social Benefits of at-house Water Supplies:3-35 [ONLINE]. Available from:
www.r4d.dfid.gov.uk/.../water/61005-DFID_HH_water_supplies_final_report.pdf. [Accessed
[15/06/2014].
FERRER, S.R., STRINA, A., RISBERO, H.C., CARINCROSS, S., RODRIGUES, L.C.&
BARRERRO, M.L. 2008. Aheirarchical model for studying risk factoras for childhood
diarrhoea: a case control study in a middle-income country. International journal for
Epidemiology, 37: 805-815.
GELTING, R. C. 2009. Water Safety Plan CDC’s Role. A National Health Institute
USA:1-2[ONLINE]. Available from:http://www.cdc.gov/nceh/ehs/Docs/JEH/2009/Nov_09
Gelting.pdf. [Accessed 20/07/2011].
203
GELTING, R.C. 2007. Household water use and health survey for the Water Safety
Plan Linden, Guyana. December 2007 US Centers for Disease Control and Prevention
(CDC):1-33 [ONLINE]. Available from: http://www.cdc.gov. [Accessed 06/04/2010].
GIBBS, J. 2015. Source of Toxic Bloemhof water found. Citizen News paper magazine.
[ONLINE]. http://citizen.co.za/193442/source-of-toxic-bloemhof-water-found/. [Accessed
16/08/2015]
GODFREE, A.F., KAY, D. & WYER, M.D. 1997. Faecal Streptococci as indicators of
faecal contamination in water. Journal of applied microbiology, 83:11OS-119S.
GOLAFSHANI, N. 2003. Understanding Reliability and Validity in Qualitative Research.
The Qualitative Report, 8(4):597-607.
Google maps South Africa. 2010.[ONLINE]. Available from: http://www.google.co.za/
maps/@-25.7759526,28.1377125,13z. [Accessed 20/06/2010].
GRAMMENOU, P., SPILIOPOUIOU, I., SAZAKLI, E. & PAPAPETROPOULOU, M.
2006. PFGE analysis of enterococci isolates from recreational and drinking water in
Greece. Journal of water and Health, 04.2:263-269.
204
GRAZIANO, A.M. & RAULIN, M. 2010. Research methods: A process of enquiry. Ally
and Bacon Publishing, 7th Edition. Newyork, USA. 288-293
GUNDRY, S., WRIGHT, J., CONROY, R., DU PREEZ, M., GENTHE, B., MOYO, S.,
MUTISI, C., NDAMBA, J. & POTGIETER, N. 2006. Contamination of drinking water
between source and point-of-use in rural households of South Africa and Zimbabwe:
Implications for monitoring the Millennium Development Goal for water. Journal of
Water and Health,1(9):1-7.
HAAS, C.N., ROSE, J.B. & GERBA, C.P. 1999. Quantitative Microbial Risk
Assessment. 2nd edition: 77-215. Wiley & sons, New York.
HALLER, L., HUTTON, G., & BARTRAM, J., 2007. Estimating the costs and health
benefits of water and sanitation improvements at global level. Journal of Water and
Health, 5(14):467-480.
HAWKINS, R. & SEAGER, J. 2010. Gender and water in Mongolia. The Professional
Geographer, 62: 16-31.
205
HAY, R., HAY, P., MLISA, A., BLAKE, D., IMRIE, S. & GOLDBERG, K. 2012. A risk-
based methodology to assess social vulnerability in the context of water infrastructure.
Water Research Commission. South Africa, Pretoria:pp 1-45.
HEMSON, D. 2007. The toughest of chores:policy and practice in children collecting
water in South Africa. Policy Futures in Education, 5(12): 315-324
HINDRON, A.I., EDWARD, J.R., HORA, T.C., SIEVERT, D.M., POLLOCK, D.A. &
FRIDKLIN, S.A. 2008. NHSN annual update: antimicrobial-resistant pathogenesis
associated with health care associated infections: annual summary of data reported to
National Health care Safety. Network at the centres of Disease control Prevention
2006-2007. Infect Control Hosp Epidemiology, 29:996-1011.
HOPE, R. 2006. Evaluating water policy scenarios against the priorities of the rural
poor. WorldDevelopment, 34:167-179.
HOSKING, S. G. & JACOBY, K. T. 2013. Trends in the insight into the growing South
African municipal water service delivery problem . No. WRC Report No. 2087/1/P/13:1-
35. Water Research Commission: South Africa, Pretoria.
206
HOWARD, G. & BARTRAM, J. 2003. Domestic water quantity, service level, and
health. Genever, Switzerland: World Health Organization Geneva:1-39 [online].
Available from: www.who.int/water_sanitation_health/diseases/WSH03.02.pdf. [Accessed
20/07/2009].
HUNTER, P.R., ANDERLE DE SYLOR, M., RISEBRO, H.L., GORDON, L. N., KAY, D.
& HARTEMANN, P. 2011. Quantitative Microbial Risk Assessment of Cryptosporidiosis
and Giardiasis from Very Small Private Water Supplies. Risk Analysis, 31 (2): 228-235.
HUNTER, P., MACDONALD, A. & CARTER, R. 2010. Water supply and health. PLoS
medicine, 7(11) :e1000361:1-10.
HUNTER, P., TORO, G.I.R. & MINNIGH, H. 2010. Impact on diarrhoeal illness of a
community educational intervention to improve drinking water quality in rural
communities in Puerto Rico. BioMed Central: Public Health, 10(11):1-11.
HUNTER, P. R. 2009a. Household water treatment in developing countries: comparing
different intervention types using meta-regression. Environmental Science and
Technology,43(7): 8991–8997.
207
HUNTER, P., POND, K., JAGALS, P. & CAMERON, J. 2009. An assessment of the
costs and benefits of interventions aimed at improving rural community water supplies in
developed countries Science of the Total Environment, 407(12):3681–3685.
HUNTER, P.R., ZMIROU-NAVIER. A & HARTEMANN, P. 2009. Estimating the impact
on health of poor reliability of drinking water interventions in developing countries.
Journal of science of total environment, 407 (8):2621-2624. 04 February 2009.
HUNTER, PR. 2008. Household water treatment in developing countries: Comparing
different interventions types using Meta-Regression. Environ. Sci. Technology J. 2009
(43):8991-8997.
IDEXX, 2001a. Colilert®-18 An easy 18-hour test for coliforms and E.coli:1-2 [ONLINE].
Available from: https://www.idexx.com/water/products/colilert-18.html. [Accesed
12/03/2011].
IDEXX, 2001b. Enterolert’s an easy 24-hour test for enterococci:1-2 [ONLINE].
Available from: https://www.idexx.com/water/products/enterolert.html. [Accesed
12/03/2011].
208
INTERNATIONAL FINANCE CORPORATION (IFC). 2009. Safe water for all:1-28
[online]. Available from: http://www.ifc.org. [Accessed 10/09/2009].
ISMAIL, H., SMITH, A.M., TAU, N.P., SOOKA, A & KEDDY, K.H. 2013. Cholera
outbreak in South Africa, 2008-2009 Laboratory analysis Vibrio cholera O1strains.
Journal for infectious diseases, 208(1): 39-45.
ITAMA, E., OLASEHA, I. O. & SRIDHAR, M. K. C. 2006. Springs as supplementary
potable water supplies for inner city populations: a study from Ibadan, Nigeria. Urban
Water Journal, 3:215-223.
JAGALS, P. 2006. Does improved access to water supply by rural households
enhance the concept of safe water at the point of use? A case study from deep rural
South Africa. Water science and technology, 54(3):8-12.
JAGALS, P., JAGALS, C. & BOKAKO, T.C. 2003. Effect of container biofilm on the
microbiological quality of water used from plastic household containers. Journal for
Water and Health, 01.3: 101-108.
JIMMY, D.H., SUNDUFU, A.B., MALANOSKI, A.P., JACOIBSEN, R.A., ANSUMANA, R.
& LESKI, T.A. 2011. Water quality associated with public health risk in BO, Sierra
Leone. Springer journal. Environmental monitoring assessment, 185:241-251.
209
JOPPE, M. 2000. The research process [ONLINE]. Available from: www.academia.edu/
930161/The_research_process [Accessed 23/11/11].
KESHAV, V., POTGIETER, N. & BARNARD, T.G. 2010. Detection of Vibrio cholerae
O1 in animal stools collected in rural areas of the Limpopo Province. Water South
Africa, 36 (2): pp167-171.
KILANKO-OLUWASANYA, G.O. 2009. Better Safe than Sorry: Towards Appropriate
Water Safety Plans for Urban Self Supply Systems. PHD thesis. Cranfield University:
88-156.
KOMENAN, 2010. Water security and the poor: evidence from rural areas in Cote
d’ivoire. Research paper. University of Cocody-Abidjan (COTE D’IVOIRE), 43:1-24.
KÜNZLE, R. & MORGENROTH, E. 2011. Household drinking-water quality in the
Kenyan Rift Valley. Master Thesis. Swiss Federal Institute of Technology:1-52.
LA FRENIERRE, J. 2008. The Burden of Fetching Water. Master dissertation.
University of Denver :4-21.
210
LARRY, D.M. 2002 Case study Theory. Journal in advances in developing Human
Resources, 4(3):333-335.
LEEDY, P.D. & ORMOND, J.E. 2005. Practical research: Planning and Design.
Macmillian, New York: 97.
LEVY, K., NELSON, K.L., HUBBARD, A. & ELSENBERG, J.S. 2010. Following the
water: A controlled study of drinking water storage in Northern Coastal Ecuador.
Journal of Environmental Health perspectives, 116(11): 1533-1540.
MAJURU, B., JAGALS, P. & HUNTER, P. 2012. Assessing rural small community water
supply in Limpopo, South Africa: Water service benchmarks and reliability. Science of
the Total Environment, 435:479-486.
MAJURU, B., MOKOENA, M.M., JAGALS, P. & Hunter, P. 2010. Health impact of
small-community water supply reliability. International Journal of Hygiene and
Environmental Health, 10 (1016):1-5.
MANSOUR, S.A.E.A. 2011. Developing GIS analysis techniques for the measurement
of safe drinking water access. D.Phil thesis. University of Southampton: 51-196.
211
MEDEMA, G.J., PAYMENT, P., DUFOR, A., ROBERTSON W., WAITE M., HUNTER
P., KIRBY R. & ANDERSSON Y. Safe Drinking Water: An ongoing challenge. In: Dufour
A, Snozzi M, Koster W (eds) Microbial Safety of Drinking Water: Improving Approaches
and Methods. OECD/WHO, Paris, 2003, 11–45.
MELLOR, J. E., SMITH, J. A., LEARMONTH, G. P., NETSHANDAMA, V. O. &
DILLINGHAM, R. A. 2012. Modeling the complexities of water, hygiene, and health in
Limpopo Province, South Africa. Environmental science & technology, 46:13512-13520.
MINNESOTAPOLLUTION CONTROL AGENCY. 2008. Minnesota River Basin Total
Maximum Daily Load Project for Turbidity: 1-2 [ONLINE]. Available from:
http://www.pca.state.mn.us/index.php/water/water-types-and-programs/minnesotas-
impaired-waters-and-tmdls/tmdl-projects/minnesota-river-basin-tmdl/project-minnesota-
river-turbidity.html. [Accessed: 20/02/2011].
MOKOENA, M. 2009. The effect of water-supply service delivery on the risk of infection
posed by water in household containers. M.S.C dissertation. University of
Johannesburg.
MORIARTY, P., BATCHELOR, C., FONSECA, C., KLUTSE, A., NAAFS, A., NYARKO,
K., et al. 2010. Ladders for assessing and costing water service delivery: 1-24
[ONLINE]. Available from: http://www.washcost.info/page/196. [Accessed: 13/02/2013]
212
MORTIMORE, S. 2000. An example of some procedures used to assess
HACCPsystems within food manufacturing. Food control Journal Elsevier, 11: 403-413.
MUKANDAVIRE Z, LIAO, S., WANG, J., GAFF, H., SMITH, D.L. & MORRIS, J.G. 2008.
Estimating the reproductive number for the 2008-2009 cholera outbreak in Zimbabwe.
Proc Natl Acad Sci USA, 108(21): 8767–8772.
NALA, N. P., JAGALS, P AND JOUBERT, G., 2003. The effect of a water-hygiene
educational programme on the microbiological quality of container-stored water in
households. Water Research, 29(6):171-176.
NAMAN J, M. M. 2012. Status of National Household Water Treatment and Safe
Storage Policies in Selected Countries:Results of global survey and policy readiness for
scaling up:1-23 [ONLINE]. Available from:http://www.who.int/household_water/WHOGlo
balsurveyofHWTSPolicies_Final.pdf. [Accessed 23/o6/2013].
NELSPRUIT NEWS, 2013. Water-Mpumalanga silent Killer. [ONLINE]. Available from:
http://showme.co.za/nelspruit/news/water-mpumalangas-silent-killer/. [Accessed
15/08/2015].
213
NENGOVHELA, 2006. Water taps run dry at Sinthumule/Kutama: 4 [online]
http://www.zoutnet.co.za/articles/news/4371/2006-06-23/water-taps-run-dry-at-
sinthumule-kutama. [Accessed 20/06/2009].
NNAJI, C. C., ELUWA, C. & NWOJI, C. 2013. Dynamics of domestic water supply and
consumption in a semi-urban Nigerian city. Habitat International, 40:127-135.
NNANE, E. D., EBDON, J. E. & TAYLOR, H. D. 2011. Integrated analysis of water
quality parameters for cost-effective faecal pollution management in river catchments.
Water Research, 45: 2235-2246.
Ozi-explorer GPS Mapping Software. 2010. [ONLINE] http://www.oziexplorer.com/.
Accessed 20/06/2010.
PAYMENT, P. & LOCAS, A. 2011. Pathogens in Water: Value and Limits of Correlation
with Microbial Indicators. Ground water, 49: 4-11.
PETER, G. 2010. Impact of rural water projects on hygienic behaviour in Swaziland.
Physics and Chemistry of the Earth, Parts A/B/C, 35:772-779.PERÉZ-VIDA, C.,
AMÉZQUITA-MARROQUIN, C. & TORRES-LOZADA P. 2013. Water safety Plans: Risk
assessment for consumers in drinking water supply. Ingeniera Y Competitividad, 15 (2):
237-251.
214
PICKERING, A. J. & DAVIS, J. 2012. Freshwater availability and water fetching
distance affect child health in sub-Saharan Africa. Environmental science & technology,
46(4):2391-2397.
POTGIETER, N., MUDAU, L. & MALULEKE, F. 2006. Microbiological quality of
groundwater sources used by rural communities in Limpopo Province, South Africa.
Water Science and Technology, 54:371-377.
PRÜSS-ÜSTÜN, A., BOS, R., GORE, F. & BARTRAM, J. 2008. Safer water, better
health: costs, benefits and sustainability of interventions to protect and promote health:
1-21 [ONLINE]. Available from: http://whqlibdoc.who.int/publications/2008/9789241596
435_eng.pdf. [Accessed 23/06/2011].
RICKET B., SCHMOIL O., RENEHOLD A. & BARRENBERG E (2014). Water safety
plan: Afield guide to improve drinking water safety in small communities. WHO,
Genever Switzerland:1-16.
RIETVELDT, L.C., HAARHOFF, J. & JAGALS, P. 2009. Tool for technical assessment
of rural water supply systems: South Africa. Science for total environment journal,
407(12):3681-3685.
215
RISEBRO, H.L., BRETON, L., AIRD HEATHER., HOOPER N. & HUNTER, P.R. 2012.
Contaminated small drinking water supplies and risk of infectious intestinal disease: A
prospective cohort study. Open access PLOS ONE, 7(8):1-12.
RUFENER, S., MÄUSEZAHL, D., MOSLER, H. & WEINGARTNER, R. 2010. Quality of
drinking water at source and point of consumption -Drinking cup as a high potential
recontamination risk: A field study in Bolivia. Journal of health population and nutrition,
28(1):34-41. International sector for diarrhoeal disease research Bangladesh.
SAID MD., FUKE N., JACOBS I., STEYN M. & NIENABER S. 2011. The case of
cholera preparedness, response and prevention in the SADC region: A need for
proactive and multi-level communication and co-ordination. Water South Africa,
37(4):559-566.
SAVICHTCHEVA, O. & SATOSHI O. 2006. Alternative indicators of fecal pollution:
Relations with pathogens and conventional indicators, current methodologies for direct
pathogen monitoring and future application perspectives. Water Research 40:2463-
2476.
SCHMIDT, WP. & CAIRNCROSS, S. 2009. Household water treatment in poor
populations: Is there enough evidence for scaling up now? Environmental Science
Technology, 43:986–992.
216
SHAMSUDDIN, S.K. & ABU, J. 2008. Bangladesh water Sector review. ITN centre,
Bangladesh University of Engineering and Technology, Dhaka, Bangladesh. Water
practice and Technology, 3(4) :1-10.
SHWE, V.D.T. 2010. A randomised trial of a household drinking water storage
intervention to assess its impact on microbiological water quality and diarrhoeal
diseases at Maela temporary shelter Tak Province, Thailand. Master dissertation.
Chulongkom University:1-87.
SIGGELKOW, N. 2007. Persuation with case studies. Acadamey of management
Journal, 50 (1):20-24.
SIMIYU, G. M., NGETICH, J. & ESIPILA, T. A. 2009. Assessment of spring water
quality and quantity, and health implications in Tongaren division, Nzoia River
catchment, Kenya. African Journal of Ecology, 47 (1): 99–104.
SMITH, J. 2010. How much water is enough? Domestic metered water consumption
and free basic water volumes: The case of Eastwood, Pietermaritzburg. Water South
Africa, 36(5):595-606.
217
SOBSEY, M. D. 2002. Managing water in the home: accelerated health gains from
improved water supply, Geneva [ONLINE]. Available from: http://apps.who.int/iris/bitstr
/10665/67319/1/WHO_SDE_WSH_02.07.pdf?ua=1. Accessed [20/07/2009].
SOLLER, J.F. 2006. Use of microbial risk assessment to inform the national estimate of
acute gastrointestinal illness attributable to microbes in drinking water. Journal of water
and health: 4(2): 165-183
SORLINI, S., PEDRAZZANI, R., PELAZZINI, D. & COLLIVIGNARELLI, M.C. 2013.
Drinking water quality change from catchment to consumer in the rural community of
Patar (Senegal). Springer journal of water quality expo health, 5:75-83 DOI 10. 1007/ s
12403-013-0089-z.
SPHERE PROJECT. 2004. Humanitarian Charter and Minimum Standards in Disaster
Response. Genever, Switzerland [ONLINE]. Available from: http://www.jobbadni.hu/js/
tinymce/plugins/filemanager/files/menupontohoz/katasztrofmce/plugins/filemanager/files
/menupontokhoz/katasztrofa/hdbk_full.pdf. [Accessed 20/07/ 2009].
SOUTH AFRICA. 1996. Constitution of the Republic of South Africa, No 108 of 1996,
2083:(17678). Government Gazzette. South Africa Pretoria: Government Printer.
218
SOUTH AFRICA GOVERNMENT COMMUNICATION AND INFORMATION SYSTEM
(GCIS). 2008. Statement by Minister of Health Barbara Hogan on the outbreak of
cholera in Zimbabwe and South Africa. 26 November 2008 ed. Pretoria, South Africa:1-
2.
SOUTH AFRICA LOCAL GOVERNMENT. 1998. Municipal structures act 117 of 1998.
Government Gazzette, 402:19614. South Africa Pretoria: Government printer.
SOUTH AFRICA. 1997. Water Service Act, 108 of 1997. Government Gazzette, 390
(18522). South Africa Pretoria: Government Printer.
SOUTH AFRICA. 1998. National water act 36 of 1998. Government Gazzette, 398
(19182). South Africa Pretoria: Government printers.
SOUTH AFRICAN BEREAU OF STANDARD. 2011. South African National Standard
(SANS) 241: 2011. Drinking water standard. Edition 7 ed: Standards South Africa:1-
23. Pretoria, South Africa.
STANDARD METHODS. 1998. Standard methods for the examination of water and
wastewater. 20th edition. Andrew DE, Lenore S, Clesceri and Arnold E. Greenberg
American Public Health Association, Washington DC:97-208.
219
STEVENS, M., N. ASHBOL, T. D. & CUNLIFF, E. 2003. Review of Coliforms as
Microbial Indicators of Drinking Water Quality-Recommendations to change the use of
Coliforms as Microbial indicators of drinking water quality. NHMRC, Biotext Pty Ltd,
Canberra, Australia.1-42.
STEYN, M., JAGALS, P. & GENTHE, B. 2004. Assessment of microbiological infection
risks posed by ingestion of water during domestic water use and full contact recreation
in mid-South African Region Water Science and Technology Journal, 5(1): 301-308.
SWART, M. 2014. Application of SANS-241-11. eWisa conference Session 2,
Municipalities. [ONLINE]available from: http://www.ewisa.co.za/misc/CONFERENCES
WISA/DWQUALITYCONFERENCES/3rdMunicipalWQConference2011/Session4.1.2_S
ANS241_Part2.pdf. (Accessed 05/08/2015).
SWIERC, S., PAGE D., VAN LEUWEN, J. & DILLION, P. 2005. Preliminary hazard
analysis and critical control point plan. CSIRO land and Techical report no 20/05/ Sept
2005 Water. University of Montana: 1-30
TAMBEKAR, D. H., GULHANE, S. R., JAISINGKAR, R. S., WANGIKAR, M. S.,
BANGINWAR, Y. S. & MOGAREKAR, M. R. 2008. Household Water management: A
systematic study of bacteriological contamination between source and point-of-use.
American-Eurasian Journal of Agriculture and Environmental Science, 3(2):241-246.
220
TAPELA, B. N. 2012. Social water scarcity and water use. Water Research Commission
(WRC) Report No. 1940/1/11:1-52. Pretoria, South Africa.
TANZANIA WATERAID. 2009. Management for sustainability. Practical lessons from
three studies on the management of rural water supply schemes:1-26 [online].
Availablefrom:http://www.google.co.za/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&v
ed=0CBwQFjAA&url=http%3A%2F%2Fwww.wateraid.org%2F~%2Fmedia%2FPublicati
ons%2Fpracticecal-lessons-rural-water-supplymanagement.pdf&ei=uvKZVPTSNMSAU-
OMgPgK&usg=AFQjCNGIb79r9MDxuGOWXR1zornHpqq9A&sig2=OjhKSLfYDk1LwB0
nWXh18Q&bvm=bv.82001339,d.d24. [Accessed 20/o8/11].
TAULO, S., WETLESEN, A., ABRAHAMSEN, R., MKAKOSYA, R. & KULULANGA, G.
2008. Microbiological quality of water, associated management practices and risks at
source, transport and storage points in a rural community of Lungwena, Malawi. African
journal of microbiology research, 2:131-137.
THABANE, L., MA, J., CHU, R., CHENG, J., ISMAILA, A., RIOS, L.P., ROBSON, R.,
THABANE, M., GOLDSMITH, C.H. A. 2010. Tutorial on pilot studies: The what, why
and How. BMC Medical research methodology,10(1):1-7.
221
TODAR, R. 2008. Pathogenic E-coli. Online textbook on bacteriology. University of
Wisconsin-Modish on Department of Microbiology: 4-10 [online]. Available from:
http://www.WearaMask.org. [Accessed 10/04 /2010].
TREVETT, A. F., CARTER, R.C. & TYRREL, S.F. 2005. The importance of domestic
water quality management in the context of faecal–oral disease transmission. Journal of
Water and Health, 03, 12:259-265.
UNICEF. 2009. Cholera outbreak South Africa National Outbreak Committee situational
report (Sitrep 29) as of 12:00 hrs 11th January 2009:1-5. [Online]
http://www.unicef.org/southafrica/SAF_emergency_cholera29.pdf [accessed,
09/08/2015].
UN-HABITAT. 2006. Strategy and action plan. Mainstreaming gender water and
Sanition. Water for Asian Cities Programme Madhya Pradesh, India:1-10. ISBN: 92-1-
131840-8.
UNITED NATIONS. 2013a. The Millennium Development Goals Report: 46-49 [online].
New York. Available from:http://www.un.org/millenniumgoals/pdf/report-2013/mdg-
report-2013-english.pdf. [Accessed 12/02/2014].
222
UNITED NATIONS. 2013b. The equitable access score-card: 1-22. United Nations
Geneva, Switzerland. [online]: Available from: http://www. unece.org/fileadmin/DAM
/env/water/publications/PWH_equitable_access/1324456_ECE_MP_WP_8_Web_Intera
ctif_ENG.pdf. [Accessed 20/03/2014].
UNITED NATIONS. 2005a. Mellinium Development goals: 5-10 [online]. New York,
United Nations. Available from: http://unstats.un.org/unsd/mi/pdf/mdg%20book.pdf.
[Accessed 20/07/2009].
UNITED NATIONS. 2005b. Gender Water and Sanitation. Policy Brief:1-16 [ONLINE].
Availablefrom:http://www.un.org/waterforlifedecade/pdf/un_water_policy_brief_2_gende
r.pdf. [Accessed 20/03/2011].
USGS. 2013. Water Quality information pH: [ONLINE] . Available from:http://water.usgs.
gov/edu/ph.html. Accesses [02/06/2009].
USGS. 2012. Water Chemistry and Electrical Conductivity Database for Rivers in
Yellowstone National Park: 1-2 [ONLINE]. Available from:http://pubs.usgs.gov/ds/632
[Accessed 23/08/2013].
223
VANDERSTOEP, S.W & JOHNSTON, D. 2009. Research methods for everyday life:
Blending quantitative and qualitative approaches. Willey and sons publishing, 1st
Edition. London: 27-243.
VERHAGEN J., JAMES A,J., VAN WIJK, C., NANAVATTY R., PARIKH M. & BHATT M.
2004. Linking water supply to poverty alleviations. International Water and Sanitation
Centre: 1-44 [online]. Available from: Delft. http//www.irc.nl/page/8760. [Accessed
08/07/2009].
WAGAH, G. G., ONYANGO, G. M. & KIBWAGE, J. K. 2010. Accessibility of water
services in Kisumu municipality, Kenya. Journal of Geography and Regional Planning,
3:114-125.
WANG, X. & HUNTER, P.R. 2010. A Systematic Review and Meta-Analysis of the
Association between Self-Reported Diarrheal Disease and Distance from Home to
Water Source . American Journal of Tropical Medicine and Hygiene, 83(3):582–584 .
WATE, S. R. 2012. An Overview of Policies Impacting Water Quality and Governance
in India. International Journal of Water Resources Development, 28(2): 265-279.
224
WATER RESEARCH COMMISSION. 2012. Draft strategic plan 2012/13-2016/17: 1-15.
Pretoria, South Africa [ONLINE]. Available from http://www.wrc.org.za. [Accessed:
15/02/ 2013].
WHO/UNICEF. 2012a. Progress on Drinking Water and Sanitation 2012 Update, United
States of America:5-48. WHO Library Cataloguing [ONLINE]. Available from http://
www.who.int. [Accessed: 24/02/2013].
WHO/UNICEF. 2012b. A toolkit for monitoring and evaluating household water
treatment and safe storage programmes:1-20 [ONLINE]. Genever, Switzerland.
Available from: http://www.who.int/household_water/resources/toolkit_monitoring
_evaluating/en. [Accessed 20/02/2013].
WHO/ UNICEF. 2012c. Joint Monitoring Programme for Water and Sanitation. Latest
report of WHO/UNICEF entitled Progress on Sanitation and Drinking-Water – 2010
Update:1-49 [ONLINE]. Available from: http://www.who.int. [Accessed: 10/03/2011].
WHO/ UNICEF. 2010. Joint monitoring Programme for water and Sanitation. Progress
on sanitation and drinking water:1-23 [ONLINE]. Available from: http://www.who.int.
[Accessed: 10/03/2010].
225
WHO/ UNICEF. 2009. Diarrhoea: Why children are still dying and waht can be done,
Genever [ONLINE]. Switzerland,WHO Library Cataloging. Available from: http:www.who
int/maternal_child_adolescent/documents/9789241598415/en. Accessed 20/02/2011].
WHO. 2011a. Guideline for Drinking Water Quality :35-56. Geneva [ONLINE]. Available
from:http://apps.who.int/iris/bitsstream/10665/44584/1/9789241548151_eng.pdf.
[Accessed: 10/03/2011].
WHO. 2011a. Guideline for Drinking Water Quality :35-56. Geneva [ONLINE]. Available:
http://apps.who.int/iris/bitstream/10665/44584/1/9789241548151_eng.pdf. [Accessed:
10/03/2011].
WHO. 2011b. Evaluating household water treatment options: Health-based targets and
microbiological performance specifications. [ONLINE]. http://www.who.int/water_sanita
tion_health/publications/2011/evaluating_water_treatment.pdf (Accessed 25/06/2013)
WHO. 2009. Water safety plan manual: step-by-step risk management for drinking-
water suppliers:1-92 [ONLINE]. Available from: http://whglibdoc.who.int/publications/
2009/9789241562638_eng.pdf. [Accessed 20/07/2011].
226
WHO/UNICEF. 2008. Joint monitoring Programme for water and Sanitation. Progress
on sanitation and drinking water. Genever/ Switzerland.
WHO. 2007. Combating waterborne disease at the household level. The International
Network to Promote Household Water Treatment and Storage. World Health
Organization, Genever, Switzerlad: 1-13.
WHO. 2001. Water quality guidelines: Standards and Health. Edited by Fewtrell L and
Bartram J:291-296. Published by IWA Publishing, London UK. ISBN: 1900222280.
WHO. 1999. Principles and guideline for the conduct of microbiological risk assessment.
CAC/GL-30. World Health Organization, Genever, Switzerland:1-25
WHO. 1997. Hazard Analysis Critical Control Point (HACCP) system and guidelines for
its application. Annex to CAC/RCP 1-1969, Rev.3. [ONLINE]. Available from: http:www.
fao.org/docrep/005/y1579e/y1579e03.htm. (Accessed 2014/06/15).
WORLD BANK. 2007. Water, Sanitation and Gender:1-2 [ONLINE]. Available
from:http://siteresources.worldbank.org/INTGENDER/Resources/Water_March07.pdf.
Accesed 31/03/ 2011.
227
WRIGHT, J., GUNDRY, S., & CONROY, R. 2004. Household drinking water in
developing countries: a systematic review of microbiological contamination between
source and point-of-use. Tropical Medicine and International Health, 9(12):106-117.
YIN, R. 2009. Case study research design and methods, United States of America,
Sage publishers:1-23. 4th Edition ISBN-13: 978-1412960991.
ZAMXAKA, M., PIRONCHEVA, G., & MUYIMA, N.Y.O. 2004. Bacterial community
patterns of domestic water sources in the Gogogo and Nkonkobe areas of the Eastern
Cape Province South Africa. Water SA, 30(6):341-346.
ZHANG, J. 2012. The impact of water quality on health: Evidence from the drinking
water infrastructure program in rural China. Journal of health economics, 31:122-134.
228
APPENDICES
229
APPENDIX A: RESEARCH QUESTIONS (CASE STUDY 1)
Date Place Interveiwee No. People 3 Time:
1. WATER SOURCE
1.1 What was your Primary water source?
Canal Borehole River Tank RWH Spring Tap
1 2 3 4 5 6 7
1.2. Is the source always has water?
Yes No
1 2
1.3. If not explain why?
1.4. What is your alternative source?
1.5. Which Source do you Prefer?
Canal Borehole River Tank RWH Spring Tap
1 2 3 4 5 6 7
1.6 Why do you prefer the Source?
Short
distance
Good taste Water
availabilit
y
Water
Safety
Technolog
y used
Other
1 2 3 4 5 6
2. WATER TREATMENT
2.1. Is your water source treated?
Yes No
1 2
2.2 If yes, who treat water?
Service
Provider
Myself at
home
Other
1 2 3
230
2.3 If treated at home, what method do you use?
Boiling Heating Chemical
Treatment
Other
2.4. For what purpose or activity do you treat your water?
Drinking Baby
Feeding
cooking Body wash other
2.5. Volume of water that you treat
1l 2l 5l 10l 15l 20l 25l 5ol 100l 200l other
1 2 3 4 5 6 7 8 9 10 11
3. WATER COLLECTION
3.1. How far is your water source from your household?
0-10m >10≤50m >50≤100
m
>100≤200
m>200m
1 2 3 4 5
3.2 How long do you travel from home to the water source?
<5minutes 6-10
minutes
11-15
minutes
16-30
minutes
31-45
minutes
46-1hour >1hour
1 2 3 4 5 6 7
3.3. How long do you wait for water at the source?
<5minutes 6-10
minutes
11-15
minutes
16-30
minutes
31-45
minutes
46-1hour >1hour
1 2 3 4 5 6 7
3.4. How long do you take to walk from the water source to your household?
<5minutes 6-10
minutes
11-15
minutes
16-30
minutes
31-45
minutes
46-1hour >1hour
1 2 3 4 5 6 7
231
3.5. How many times do you collect water from the source per day?
1 2 3 4 5 >06(specif
y)
1 2 3 4 5 6
3.5. How many times do you collect water from the source per week
1 2 3 4 5 >06(specif
y)
1 2 3 4 5 (15)6
3.6. Who collect water?
Children Mother Father Other
(specify)
1 2 3 4
3.7 How do you carry water from the source to a household?
Carry on
head
Wheel
barrow
Rolling
drum
along
ground03
Carry on
back of
LDV
Animal
drawn
cart
Other(spe
cify)
1 2 3 4 5 6
3.8. What method do you use to extract water from the source?
Stepping
into water
Not
stepping
into water
Dug well
at the
river bank
Rinsing
water at
the point
of
collection
source
Collecting
water
directly
from pipe
or tap
Animal at
source
drinking
and
Crossing
Bathing at
source
Washing
clothes at
source
1 2 3 4 5 6 7 8
232
5. Container
5.1 What are the kinds of containers used?
Plastic
small
mouth
with lid
Plastic
small
mouth
without
l id
Plastic
wide
mouth
with lid
Plastic
wide
mouth
without
l id
metal
small
mouth
with lid
Metal
small
mouth
without
l id
Metal
wide
mouth
with lid
Metal
wide
mouth
without
l id
5.2. How many containers do you fi l l per day?
1 2 3 4 5 >06(specif
y)
1 2 3 4 5 6
5.3. Container hygiene observation and how they clean it.
Greenish
layer
–inner
side walls
of vessel
Muddy
layer
inner
bottom of
vesssel
Cracks/s
walls(insi
de and
outside)
Greenish
layer
inner side
walls of
scooping
equipment
Muddy
layer
inner
bottom of
scooping
equipment
Cracks on
scooping
equipment
(outside &
inside)
Rinse
outside
only
Rinse
inside
only
Wash with
soap inside -
out
Wash with
soap and
mud inside
out
Wash with
only soil
inside-out
Other
1 2 3 4 5 6 7 8 9 10 11 12
233
5.4. Do you use the same container for collection and water storage? Yes/no
5.5. If not what kind of container volume do you use?
1l 2l 5l 10l 15l 20l 25l 5ol 100l 200l other
1 2 3 4 5 6 7 8 9 10 11
6. Water availability
6.1. Do you experience any breakdown?
Yes No
1 2
6.2. How long does it take to be fixed?
Same day Week Month >Month >3Months >6Months Other
1 2 3 4 5 6 7
234
6.3. What day is water not available?
Same day Week Month >Month >3Months >6Months Other
1 2 3 4 5 6 7
6.4. How often is water not available?
Same day Week Month >Month >3Months >6Months Other
1 2 3 4 5 6 7
6.5. What is the time of the day when water is available?
Early in
the
morning
Mid-
Morning
Late
Morning
Afternoon Late
afternoon/
early
evening
Whole day
1 2 3 4 5 6
6.6. What other alternative source do you use?
Canal Borehole River Tank RWH Spring Tap
1 2 3 4 5 6 7
7. Water use
7.1 What kind of activity do you use water for?
Drinking cooking Baby
feeding
bathing Washing
dishes
Laundry Gardening Animal
drinking
Other
(Specify0
1 2 3 4 5 6 7 8 9
7.2. What volume of water do you use for each activity above? (Estimate)
Drinking cooking Baby
feeding
bathing Washing
dishes
Laundry Gardening Animal
drinking
Other
(Specify0
235
7.3. What type of water source do you use for above activities (Specify)
Drinking cooking Baby
feeding
bathing Washing
dishes
Laundry Gardening Animal
drinking
Other
(Specify0
Tap Tap Tap Tap Tap River Tap River
7.4. If different source are used for the above activities specify why? ____________________________________________________________________
7.5 How do you store your water? ______________________________________________________________________________________
8. Comparison of water service before and after the availability of taps.____________________________________________________________________
8.1. When were you provided with the taps? __________________________________________________________________________________________
8.2. Is the water always available? ________________________________________________________________________________________________________________
8.3. If not what causes the water to be unavailable? _______________________________________________________________________________
8.4 What other source do you use? We use river water. _______________________________________________________________________________
8.5. Since taps were provided do you use different sources other than taps? _____________________________________________________________________
8.6. If other sources are used for what purpose are those sources used for? _____________________________________________________________________
236
8.7. Is the distance and access to water improved? Yes/no __________
8.8. If not improved please specify. _______________________________________________________________________________
8.9 Is the volume of water used in the household increased? Yes/no
8.10. If yes specify the water volume used now as compared to the years before the availability of taps. ______________________________________
8.11 Do you think the provision of taps is beneficial to the community? Yes/no __________________________________________________________
8.12. Support your answer. ________________________________________________________________________________________________________________
9. COMMUNICATION ON WATER SERVICE
9.1. How is the communication on water service before and after the water project?
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
9.2. Health Education
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
237
APPENDIX B: HOUSEHOLD SURVEY QUESTIONNAIRE (CASE STUDY 2)
Project is focusing on the domestic management of water, waste and hygiene;
and its effect on environmental and human health in rural villages.
Date of survey: ________________________________________________
Village: _______________________________________________________
Household Number (HHN): ____________________
NB: If this household is not on our system please GPS-mark and note the waypoint
and coordinates at the space provided at the bottom of this page
Head of Household:
Father Mother Child headed Other
Only to be filled in if the household is not on our system
Waypoint: ______________________________
Date marked (way pointed): ______________________________
Coordinates: S_____________________________
E_____________________________
238
Team details:
Team member: _____________________________________
Quality control: Checked by (Print name): ________________________________
Signature:___________________________________Date: _______________
Section A: Demography data
Question 1: Respondent level
1.1. Description of gender. Female Male
1.2. What is your date of birth? ______________________________
1.3. What is your marital status?
1.4. What is your relationship to the head of household?
1.3. Single Married Widowed Divorced Live-in Partner
1.4. What is your relationship to the head of household?
Head of the household
Wife of the head
Son
Daughter
Brother
Sister
Brother in law
Sister in law
Mother
239
Father
Mother in law
Father in law
Others (Specify)
Question 2: Household members
2.1. What language does the HH predominantly speak?
2.2. What is each member’s relationship to the HH? (Use legend provided)
2.1.
Language
2.2. Relationship to HHH Code
Head of household 1
Spouse 2
Son 3
Daughter 4
Brother-in-law 5
Sister-in-law 6
Sister 7
Brother 8
Mother of head 9
Father of head 10
Mother of wife 11
Father of wife 12
Other (other relatives, live-in partners etc)
13
240
2.3. What is the marital status of each member? (Use legend provided)
2.3. Marital status (MS)
Single Married Divorced/ Separated
Widowed Live in Partner
Code 1 2 3 4 5
2.4. What is the gender of each member? (Use legend provided)
ID 2.2 Relationship to HHH
2.3 MS
2.4 Gender
2.5 Age
2.6 Education
2.7 Collect water
1 1 2 M F 60 17
2 3 1 M F 14
3 M F
4 M F
5 M F
6 M F
7 M F
8 M F
9 M F
10 M F
2.5. How old is each member?
2.6. What is the highest level of education for each member? (Use legend provided)
2.6. Highest qualification level Code
Pre-primary 1
Grade R 2
Grade 1 3
Grade 2 4
Grade 3 5
Grade 4 6
Grade 5 7
Grade 6 8
Grade 7 9
Grade 8 10
Grade 9 11
Grade 10 12
Grade 11 13
Grade 12 14
Tertiary Certificate/Diploma/Degree (specify)
15
241
2.7. Indicate who collect water in the household? (Tick)
Question 3: Household income and migration
3.1. Do you have any means of income? (Use legend provided)
3.2. What type of employment are the HH members involved with? (Use legend
provided)
3.3. If the HH members are receiving an income other than government grants, in which
sector are they involved in? (Use legend provided)
3.4. If the HH members receive government grants, what kind of grant do they receive?
(Use legend provided)
3.5. How much money does each contributor in the household receive every month?
(Use legend provided) this include all the household income.
ABET (Adult school) 16
None 17
3.1. Earn income (EI)
Yes No
Code 1 2
Formally
Employed/Self-employed: If person works for a salary or shares in profits of a registered firm.
Informal activity: Person involved in informal activities for 3 days or more/food/accommodation.
Unemployed: Those who can work, want to work, but cannot find work.
Grant holders: Those that are pensioners, sick or disabled, child support grants
None
1 2 3 4 5
242
3.4. Type of grant (TG)
Old age pension grant
Disability grant Child support grant
Other
Code 1 2 3 4
3.5. Approx. monthly hh member income (MI)
R 0< R 500
> R 500
≤ R 1,000
> R 1,000
≤ R 2,000
> R 2,000
≤ R 3,000
> R 3,000
≤ R 4,000
> R 4,000
≤ R 5,000
> R 5,000
Legend 1 2 3 4 5 6 7
3.1 Means of income 1
3.2 Type of employment 4
3.3 Sector of employment
3.4 Type of grant 1
3.5 Monthly HH member income
4
3.3. Which sector of employment (ES)
Code
Agriculture 1
Mining, quarrying 2
Manufacturing 3
Electricity, water, gas 4
Construction 5
Government 6
Wholesale, retail, trade, catering 7
Transport, storage, communication
8
Financing, insurance, real estate 9
Community, social or personal services
10
Informal activity 11
Other (specify) 12
243
Question 4: Household Expenditure
4.1. What is the household expenditure for the different services per months?
4.1. Type of expenditure Yes No 4.1 R Value
Rent and services (water, waste, electricity) R
Food R
Energy (Energy coal, wood and paraffin) R
Clothing R
Transport R
Medical expenses R
Furniture, radio, etc. R
Agricultural expenditure (average) R
Others R
Average total (if breakdown unclear) R
Specify other:
______________________________________________________________________
Question 5: Utilities and commodities
5.1. Which of the following facilities and services are already available to this
household?
5.2. If you had money and you could buy any of the facilities or services you do not
already have, how much would you spend on each?
5.3. What assets do your household own?
5.4. What Rand value do you place on each?
244
5.1 Facility/Service Available Not Available
5.2 Willingness to pay
Water services
Water on site R
Sharing a tap with a neighbour R
Sanitation
Flush toilets R
Sharing a toilet with a neighbour R
Pit latrine R
Energy
Electricity on site R
Pavement street lighting R
High-mast street lighting R
Road Gravel roads R
Walk ways/ human path R
5.3 Commodity Available Not Available 5.4 Value placed (Rand)
Motor vehicle R
TV R
Fridge R
Furniture R
Question 6: Housing
6.1. How many households live on this site?
6.2. If more than one household on this premises, how many houses/huts/units are
occupied by your household members?
6.3. Indicate the category of housing? (Use legend provided)
6.4. What kind of housing do you prefer? (Use legend provided)
6.5. What materials is the house made of? (Use legend provided)
245
6.6. What materials is the roof made of? (Use legend provided)
6.7. Indicate what other activities the room where the water is stored is used for (Use
legend provided)
6.8. Do you have problems with your present accommodation? (Tick)
6.3 Housing categories Code
Mud hut (constructed from locally produced products) (Round or square shaped)
1
Small scheme housing (toilets and taps) 2
Larger scheme housing (RDP housing) 3
Plot and plan (serviced stand) 4
Individually designed housing 5
Low-density informal housing (shacks) 6
High-density informal housing (shacks) 7
RDP -housing 8
Semi-detached houses (2 units per structure) 9
Semi-detached houses (more than 2 units per structure) 10
Other 11
6.4 House preference Code
A house financed by building society Loan (R1 000+ conventional house) 1
A house financed by S.A Housing Trust (R250 pm two-room brick house which is subsidised)
2
A house financed by S.A Housing Trust (R250 pm two-room brick house which is not subsidised)
3
A self-help house (rent of site and services only) 4
Free house 5
6.5 Materials of structure Brick Mud Wood Other materials
Code 1 2 3 4
246
6.6 Materials of roof
Tiles Corrugated iron
Thatch Wood Other materials
Legend 1 2 3 4 5
6.7 Room Uses
Water storage
Kitchen Dining Area
Common area
Sleeping Bathing Store Other
Legend 1 2 3 4 5 6 7 8
6.1 Nr of HH on site
6.2 Nr of people living on premises
6.3 Housing category
6.4 Housing preference
6.5 Materials of structure
6.6 Materials of roof
6.7 Activities
6.8 Accommodation problems Yes No
Too far from employment opportunities, shopping, recreation or sports facilities
The neighbourhood is not good enough (e.g. in terms of safety, attractiveness, etc.)
Too small for the number of people living here (overcrowded)
Too expensive (in terms of monthly service charges, rent and/or bond payment)
The construction is of inferior quality (e.g. not protecting you from the elements, large cracks in the walls, etc.)
The services available on the site (water, electricity, sewage and waste disposal) are inadequate
The facilities in the house (e.g. water on tap, toilets or lighting and/or heating facilities) are inadequate
247
Question 7: Energy uses
7.1. What kind of energy sources used for this household? (Use code provided)
7.2. Give an estimate on what you pay for each source each month? (Value in Rand)
7.1 Energy sources
Eskom Electricity
Solar power
Paraffin Gas Wood Coal Animal Dung
Candles Other
Code 1 2 3 4 5 6 7 8 9
7.1. Energy source application
Code
Warming or boiling water
Cooking
Lighting
Appliances
Other
Other: specify:
7.2. Value for energy source Rand
Eskom electricity R
Solar power R
Paraffin R
Gas R
Wood R
Coal R
Animal dung R
Candles R
248
Question 8: Health
8.1. What are the health problems in the family; did anyone have treatment for these in
the past 12 months? (You can tick more than one)
Type of diseases Peoples’ number
Number treated
Number not treated
Diarrhoea
Cholera
Neck pain
Back pain
Chronic bowel conditions (Diarrhoea, colitis or constipation)
Bilharzia
Malaria
Trachoma
Fever
Heart disease
Worms infection
Other (specify)
No problem
8.2. Disability Screening Questions
8.2.1 Do any of your HH members have any difficulty in doing day to day activities because of a physical, mental or emotional (or other) health condition which has lasted or is expected to last for 6 months or more?
Peoples’ number
Yes No
8.2.2 Do any of your HH members ever need assistance in participating in any of the following activities? (Walking, seeing, speaking, hearing, breathing, mental coping, learning comprehending)?
8.3 Screening for Musculoskeletal Impairment Questions [2]
8.3.1. Is any part of your body missing or misshapen?
Do you have any HH member who have difficulties using the following:
Other: specify: R
249
8.3.2. Arms?
8.3.3. Legs?
8.3.4. Body?
8.3.5. Need a mobility aid or prosthesis
8.3.6. Convulsions, involuntary movement, rigidity or loss of consciousness
If any of the answers are yes:
8.3.7. Has it lasted more than one month?
8.3.8. Is it permanent?
8.2 Does anyone in the household have the diarrhoea in the past week?
8.3 If yes how many were affected and what are the ages of those household
members? (use legend)
8.4 What was the duration of diarrhoea condition?
8.5 What triggered the diarrhoea?
8.6 Did you treat the diarrhoea and where did you go? (clinic, doctor, hospital, traditional
healer, private facility)
8.2 Diarrhoea in the past week Yes No
8.3 Nr affected by Diarrhoea and their age
Less than 5yrs
Greater than 5 but less than60
Greater than 60
8.6 Duration of diarrhoea
Half day
1 day 2 days 3 -4 days
5-7 days
8.7 Condition triggered diarrhoea
8.8 Treatment of diarrhoea Yes No
Place of Treatment
Public Health facility
Private health facility
Traditional healer
Other specify:
____________________________
250
_________
Question 9: Personal and Domestic Hygiene
Personal Hygiene
9.1. Do you wash your hands? Yes No
9.2. If yes, what do you use to wash your hands with? (you may tick more than one)
Cold water
Warm water
Soap/Disinfectant
Clean cloth
Dirty cloth
9.3. When do you wash your hands? (you may tick more than one)
When handling water used for drinking
When visibly soiled
After touching something contaminated
After using the toilets
After changing nappies
Before preparing food
Before meals
9.4. How many times per day do you wash your hands?
__________________________
9.5. How many times do you wash your whole body per week?
__________________________
Domestic Hygiene
251
9.6 How do you keep insects away from food? (Tick from the box below)
9.7 Do you cover the food that you are not using or before consumption? (Observer)
9.8 Do you rinse food before preparing it? (Explain)
9.9 With what to you clean the dishes with?
9.10 Do you wash your cooking utensils after using them?
9.6 Insects Tick
Cover food with cloth
Cover with food lid
Insect repellent
Insect swatter
No method
Other
9.7 Cover food Yes No
9.8 Rinse food Yes No
Explain (Not clear)
9.9 Dry Tick
Clean cloth/towel
Dirty cloth/towel
Wipe on clothing
Other
252
Section B: Water
Question 10: Water collection
10.1 Where do you collect the water that you have in this household? (Tick)
10.2 What is your alternative water source?
10.2.1 How many times do you fill each vessel (filling events = FE)?
10.2.2 At what time do you collect the water?
10.2.3 How often do you collect water?
10.2.4 To what level do you fill each container?
10.2.5 How do you clean your water collection container?
9.10 Wash cooking utensils
Yes No
10.2.2 Filling times
Early morning 04:00 – 07:00
Mid-morning
07:00 – 10:00
Late morning
10:00 – 13:00
Afternoon 13:00 – 16:00
Late afternoon / early evening
16:00 – 19:00
Random
Code 1 2 3 4 5 6
10.2.3 Frequency
1 x pd Every 2ndday
Every 3rdday
Every 4thday
Every 5thday
Every 6thday
Every 7thday
Code 1 2 3 4 5 6 7
10.2.4 Filling margins (%)
100 90 80 75 60 50 25
Code 1 0.9 0.8 0.75 0.66 0.5 0.25
253
10.3: Categorise the capacity (volume in litres) of collection vessels as well as
numbers of each.
10.4: Number of each type of vessel
10.5: Do you have drilled well?
10.2.5 Cleaning methods
Rinse outside only
Rinse inside-out
Wash with disinfectant soap
Wash with soap inside-out
Wash with soap and sand inside-out
Wash with sand only inside-out
Other
Obs 1 10.2.2 10.2.3
10.4/Observation 2
10.2.4 Plastic
Screw top
Plastic
Wide mouth
Metal
Wide mouth
Other (Spec below)
10.3 Capacity (litres)
Filling Time
Filling Freq
No cap
Cap No lid
Lid No lid
Lid Cap No Filling margin
10.2
.1
20
FE 1 2 1 1 1 0,1
FE 2 4 3 2 1
FE 3
FE 4
50
FE 1 5 7 2 1
FE 2
FE 3
FE 4
25
FE 1 1 `1 1 0.9
FE 2 3 1 1 0.9
FE 3 5 1 1 0.9
FE 4
254
10.6: Is water connected at the tank?
10.7: If yes, how often do you clean your tank?
Specify other:
______________________________________________________________________
10.5. Do you have drilled well Yes No
10.6. Is your water connected to the tank? Yes No
10.7. If yes, how often do you clean your tank?
10.8. What method do you used to clean your tank? (Use a lagend)
Question 11: Water usage
11.1 What do you use your water for? (Mark from the list)
11.2 Do you use any other water for drinking other than the primary source?
(Tick) Yes No
11.3 What volume of water do you use for the various uses? (Use legend provided)
11.4 What source do you use for your various water uses? (Use legend provided)
10.7 Frequency
1 x week 1 x /month 1 x /6month
1 x /year Never Not sure Other
11.3 Water Volumes
250mℓ 500mℓ 750mℓ 1ℓ 2ℓ 3ℓ 4ℓ 5ℓ 6ℓ 7ℓ 8ℓ 9ℓ 10ℓ Other
Code 1 2 3 4 5 6 7 8 9 10 11 12 13 14
255
11.5 Do you treat your water? (Tick)
11.6 If you do treat the water, how do you treat it?
11.6 Treatment Household bleach Boiling Filter Other
Code 1 2 3 4
11.5 Treatment 11.6
11.1 Water use 11.3 Volumes 11.4 Source Yes No Treatment type
Drinking
Cooking
Hand washing
Food prep
Dish washing
Body washing
Nappy washing
Baby-milk prep
Laundry
Animal drinking
Garden water
House cleaning
Other
Specify other:
_____________________________________________________________________
Question 12: Water availability
12.1 Is water sometimes not available at your regular source?
11.4 Source
Yard standpipe
Communal standpipe Borehole Tank RWH
Natural resource
(Specify)
Bottled water
Private drilled well
Other
Tick 1 2 3 4 5 6 7 8 9
256
12.2 If yes, how often is water not available?
12.3 If water is unavailable daily, at what time of day is it unavailable?
12.4 When was the last time water was unavailable at source?
12.5 How long did it take to get fixed?
12.2 How often not available
Daily Weekly Monthly Every 2 months
Every 6 months
Annually Other
Tick
12.3 Time of day
Early morning
Mid-morning
Late morning
Afternoon Late afternoon/early evening
Whole day
Randomly
Tick
12.45 Last time unavailable
Week ago
2 Weeks ago
Month ago
3 months ago
6 months ago
Annually Other
Tick
12.5 Fixing time
Same day
Week Month > Month
> 3 Months
> 6 Months
Year Other
Tick
Specify other:
______________________________________________________________________
12.1 Water Availability
Yes No
257
12.6 If water is not available do you buy water? Yes No
12.7 If yes how much do you spend per
day?______________________________________
Question 13 Water accessibility
13.1 How far do you think the source is from your house (in paces)?
13.2 Measure distances (Estimate)
13.1 & 13.2 Distance in Paces
0-10m >10≤50m >50≤100m >100≤200m >200m
Code 1 2 3 4 5
13.3 How many trips do you travel per day from the household to the water source
13.3 Trips number: _______________________________________
13.4 How long do you wait at the source to collect water?
13.4 Waiting time: ________________________________________
13.5 How do you carry water in containers from source to home?
Source Yard standpipe
Communal standpipe
Bore-hole Tank RWH Natural source
Private Drilled well
Other
13.1 Estimated distance
13.2 Measured distance
Coordinates of source
S
E
258
Question 14: Container hygiene and storage
14.1 Do you wash the vessel before each filling?
14.2 What type of container do you use?
14.1 Yes No
14.2 14.3 Container hygiene inside
14.4 Container Hygiene outside
14.5 Cleaning method
14.6 Prior use
Plastic screw top (open)
Plastic screw top (closed)
Plastic wide mouth (open)
Plastic wide mouth (closed)
14.3 Describe the container hygiene inside. (Use legend provided)
14.4 Describe the container hygiene outside. (Use legend provided)
14.5 How do you clean your containers? (Use legend provided)
13.5 Transport
Carry by hand
Carry on head Wheelbarrow Rolling drum on ground
Carry on back of LDV
Animal-drawn cart
Other
Tick
14.3 Hygiene-related aspects (inside) Code
Biofilm 1
Loose particles 2
Clean 3
14.4 Hygiene-related aspects (outside)
Code
Very dirty (sticky pigmentation) 1
Excessive scratches 2
Clean 3
259
14.6 What was the prior use of the container? (Use legend provided)
Specify other:
______________________________________________________________________
14.7 Where did you get the container that you are using?
______________________________________________________________________
_______________
Question 15: Storage conditions
15.1 Are the storage containers stored inside or outside the dwelling? (Tick)
15.1
Inside Outside
15.2 Describe the areas where the water is stored. (Use legend provided)
15.3 How do you scoop water from the water container?
14.5 Cleaning methods
Rinse outside only
Rinse inside-out
Wash with disinfectant soap
Wash with soap inside-out
Wash with soap and sand inside-out
Wash with sand only inside-out
Other
Code 1 2 3 4 5 6 7
14.6 Prior use Rank
Newly bought (from shelf) 1
Used for foodstuff storage 2
Used for chemicals 3
Other 4
15.3 Water scooping Tick
260
15.4 How long do you store water?_____________________
15.5 How much water do you drink in household per day?______________________
15.6 What do you do to keep insects (flies cockroaches) away from the water
containers?
Scooping vessel
Hands
Tip container
15.2 Storing conditions Tick
Cool and dark/shady
Hot/warm and light
Dusty
Dirty floor
Dung floor
Clean
Insects visible
Animals access to water
Children access to water
Other
Other
15.6 Insects Tick
Cover containers with cloth
Lids/caps on containers
Insect repellent
Insect swatter
No method
Other
261
APPENDIX C: ETHICS APPROVALS
TUT Ethics committee permission for current work (to be used for Case
study 1)
November 3rd
, 2008 Ref#: 2008/10/032 Name: Prof Jagals P [Paul] Student #: Staff Member
Prof P Jagals (Former supervisor already got permission prior to my studies)
Department of Environmental Health
Faculty of Science
Pretoria Campus
Dear Prof Jagals
TITLE: “A Toolkit to measure sociological, economic, technical and health, impacts and benefits of 10 years of
water supply and sanitation interventions in South Africa”.
INVESTIGATOR: JAGALS P PROF
PROGRAMME: Non Degree Purpose Research
Thank you for submitting the proposal and addenda for evaluation.
In reviewing the proposal, the following comments/notes – emanating from the meeting, are tabled for your
consideration:
Appendix A, page 2, heading: What are your rights and assurances? Second last bullet: “The final results
might also be published in national and international scientific journals. This will be done in such a way that
you, your family and your premises will not be identified”.
It is recommended that the results of the research be made available to the local municipalities. It is a Water
Commission funded project, so they will have automatic access to the results. This recommendation should
be reflected in the Informed Consent as well.
Appendix A, page 2, heading: What are your rights and assurances? Last bullet: The Chairperson of the
Research Ethics Committee is Dr Braam Hoffmann and not Prof Danie du Toit. The correct contact number
should also be reflected as 012-382 6259.
The Informed Consent document [Appendix A] should be translated into the local language.
The Research Ethics Committee of Tshwane University of Technology reviewed the proposal and addenda at the
meeting held on October 27th, 2008 and approval for the proposal is hereby granted.
It is recommended that the aforementioned revisions be taken into account.
The Committee wishes you well with your research endeavours.
Yours sincerely,
Research Ethics Committee
262
WA HOFFMANN (Dr)
Chairperson: Research Ethics Committee
[Ref#2008=10=032=ProfJagalsP] cc FRIC Chairperson: Prof P Marais, Faculty Officer: Ms
T Coetzee
263
264
265
APPENDIX D: PROVISIONAL INFORMED CONSENT FORM
Project Information for informed consent
Project leader: Professor Paul Jagals (Environmental Health) - Tshwane University of Technology
Team leaders: ___________________________________
___________________________________
Field workers: FW 1_____________________________ FW
2_____________________________
FW 3_____________________________ FW 4_____________________________
FW 5_____________________________ FW 6_____________________________
We are researchers from the Tshwane University of Technology. We are doing a research
project on benefits of the water and sanitation services used by the people in villages in this
area.
The project has been approved by the Ethics Committee of the Tshwane University of
Technology as well as the Limpopo Department of Health.
We will now explain the project and will then request your participation.
Faculty of Science
Department of Environmental Health
HH Number: _______________________
HH Name: __________________________________
266
The project
The project name is: Assessment of environmental health aspects related to water,
sanitation and hygiene in poor and rural households;
The purpose of the study is to determine whether the water and sanitation services in the
area have influenced your health, the environment, your social and economic situation and
whether the services are of good technical quality.
What is expected of you?
Between one and three interviews will be conducted here on your premises over the next
three months. Each interview will take approximately 60 minutes;
These interviews will be of a sensitive nature and will include aspects of:
The health of you and your family, in particular, on illnesses you might experience that are
related to water sanitation and hygiene;
The feelings you have about the water sanitation and hygiene situation in your area;
Economic issues including the family income and other economic activities related to water
sanitation and hygiene;
We request that you and your family allow observations to be done and help us keep record
over the next three months of the way your family collect water, do sanitation and practice
hygiene;
Allow us to take water and other environmental samples from your home and surroundings;
Help us understand the disease profile in your family by keeping record for us, on specific
forms, of illnesses and other issues relating to your water, sanitation and hygiene situation;
Your names and address (these will be used for your household identification with a GPS-
marking);
Photos of your house as well as the water, sanitation and hygiene infrastructure. This is for
record and recall purposes.
267
What are your rights and assurances?
This study is completely voluntary and you or your family are under no obligation to
participate;
If you feel that you do not want to be part of the study anymore at any time, you are free to
withdraw at any time - even if you have signed this consent form. You will not be required to
give reasons for withdrawing and your information will not be included in the results of the
study;
No monetary compensation is offered for your participation nor will you be expected to pay
anything;
Other than sensitive questions that might make you feel uncomfortable, the project activity
does not pose any risks of physical harm in any way for you and your family;
You and your family’s details will be kept strictly confidential at all times;
There was no particular reason for choosing your household. Your house was randomly
selected;
You have time to think about whether you should consent– please indicate if you want this
time;
You are free to ask any questions, at any time, about the study;After the project is completed
and all the data have been analysed, we will come back to your community and give
feedback on what we have found during the study. This will be done in such as way that
you, your family and your premises will not be identified;
The final results might also be published in national and international scientific journals. This
will be done in such as way that you, your family and your premises will not be identified.
The primary investigator and person in charge of this project is Professor Paul Jagals. He
can be contacted during office hours at Tel (012) 382-3543. Should you have any questions
regarding the ethical aspects of the study, you can contact the chairperson of the TUT
Research Ethics Committee, Dr Braam Hoffmann, during office hours at Tel (012) 382-6259.
We now request you to participate in this study.
268
Respondent:
I have heard the proposed activities of the project. The activities are clear to me;
I understand that there will be no harm to me and my family;
I was given adequate time to think about the issue before I consent;
I was and still am provided the opportunity to ask questions;
I have not been pressurised to participate in any way;
I understand that participation in this research project is completely voluntary;
I understand that I will not receive any monetary compensation for my participation and that
participation will not cost me anything;
I understand that I may withdraw from the study at any time without supplying reasons and
without prejudice;
I confirm that I may speak on behalf of my family;
I consent to supply personal details of me and my family. The condition is that while the
details will be involved in the analysis of the results, it will not be used in any way to breach
confidentiality;
I understand that this research project has been approved by the Research Ethics
committee of the Tshwane University of Technology;
I am fully aware that the results of these projects will be used for scientific purposes and may
be published. I agree to this, provided my privacy is guaranteed.
I hereby consent to participate in this project and can sign for this
consent.
_______________ __________________ _______________ ___________
Name of respondent Signature Place Date
269
I hereby consent to participate in this project and but cannot sign because of
illiteracy. I requested the interviewer to confirm on my behalf
_______________________ ________________________
Name of respondent Mark of respondent
Statement by Interviewer
The respondent indicated that the content and activities of this form is understood
and has requested that I confirm and sigh consent on her / his behalf.
_______________________ __________________ _______________ ________
Name of interviewer Signature Place Date
Statement by Interviewer
I have provided the respondent with verbal information regarding this Research Project. The
respondent indicated that the content and activities of this form is understood. I have left a
signed copy of this form, translated into _________________, with the respondent.
______________ __________________ _______________ _______
Name of interviewer Signature Place Date
270
APPENDIX E: TYPE OF WATER SOURCES USED AS PER SOCIO-ECONOMIC STATUS-WATER SOURCES
Water sources
All Sinthumule
Tshifhire 1 - 3 people
4-5 people
6+ people
<10th grade
1- or 11 grade
Grade 12
Tertiary <R1000 R1000- R2000
>R2000
201 121 80 53 66 82 44 51 52 51 62 68 63
Primary Water Source
Yard standpipe
42 9 33 6 14 22 2 9 16 15 6 12 21
Communal standpipe
87 60 27 21 29 37 27 22 21 17 31 32 22
Borehole 9 9 0 3 4 2 1 1 1 6 1 3 5 Tank 1 1 0 1 0 0 0 1 0 0 1 0 0 Spring 17 0 17 10 3 4 5 5 5 2 6 8 3 Private drilled well
41 41 0 11 15 15 8 13 7 10 16 11 11
RWH 3 0 3 1 1 1 1 0 2 0 1 2 0 Alternative water source
Yard standpipe
10 9 1 3 3 4 1 4 2 3 3 1 3
Communal standpipe
11 6 5 4 2 5 0 1 4 5 3 4 3
Borehole 6 6 0 3 1 2 3 1 1 1 2 1 3 Tank 13 13 0 2 7 4 1 3 4 5 8 2 3 RWH 3 3 0 0 1 2 1 1 0 1 1 1 1 Spring 54 0 54 7 18 29 9 12 16 17 11 20 23 Private drilled well
54 53 1 15 19 20 15 16 13 8 19 20 13
other 5 1 4 1 2 2 0 0 4 1 0 2 3 No alternative
44 33 11 10 11 23 9 8 10 17 8 17 19
271
APPENDIX F: WATER AVAILABILITY AS PER SOCIO-ECONOMIC STATUS
All Sinthumule
Tshifhire
1 - 3 people
4 - 5 people
6+ people
<10th grade
1- or 11 grade
Grade 12
Tertiary
<R1000
R1000 - 2000R
>R2000
All 201 121 80 53 66 82 44 51 52 51 62 68 63 Water available Yes 159 84 75 42 51 66 36 43 40 39 47 58 49 No 79 75 4 4 11 7 6 3 5 6 8 4 9 Period not available
Daily 12 8 4 2 6 4 4 0 3 5 3 3 5 weekly 58 32 26 18 14 26 15 17 15 11 20 23 15 monthly 9 8 1 5 0 4 1 4 4 0 3 4 2 bi-monthly 5 4 1 1 0 4 1 3 1 0 1 2 1
6 months 27 27 0 7 14 6 6 12 4 4 14 7 4
Annually 49 3 46 10 18 21 7 8 17 17 9 20 20 Time of the day Unavailable
early morning 15 12 3 5 3 7 5 3 3 4 7 3 5 mid-morning 13 12 1 4 5 4 4 4 3 2 3 6 3 late-morning 22 8 14 5 3 14 3 5 9 5 5 8 9
afternoon 7 2 5 3 2 2 3 1 2 1 3 3 1 early-evening 3 3 0 0 1 2 1 1 1 0 0 2 0
whole day 4 4 0 1 1 2 1 0 1 2 2 2 0 randomly 85 34 51 22 29 34 15 28 21 21 25 32 25
272
APPENDIX G: PERIOD WHEN COMMUNAL WATER WAS AVAILABILITY AS PER SOCIO-ECONOMIC STATUS
All Sinthumule
Tshifhire
1 - 3 people
4 - 5 people
6+ people
<10th grade
1- or 11 grade
Grade 12
Tertiary
<R1000
R1000 - 2000R
>R2000
All 201
121 80 53 66 82 44 51 52 51 62 68 63
Last time unavailable
Week-ago 62 19 43 16 21 25 14 12 21 15 19 23 19
2 weeks-ago 21 16 5 8 1 12 6 10 0 5 6 8 6
Month-ago 11 10 1 3 4 4 4 3 4 0 4 5 2
3 Months-ago 5 3 2 0 1 4 0 1 3 1 0 2 3
6months-ago 5 3 2 1 2 2 0 2 1 2 1 2 2
Year-ago 32 25 7 8 15 9 5 14 8 4 17 9 4
>year 16 2 14 4 5 7 4 0 4 9 1 7 8
fixing time
Same day 35 20 15 12 12 11 8 10 10 7 13 14 8
Week 66 25 41 18 12 36 11 18 20 17 15 26 24
Month 6 1 5 3 2 1 3 1 1 1 3 2 1
>month 7 6 1 1 2 4 2 1 1 3 1 3 3
>3 months 1 1 0 1 0 0 1 0 0 0 0 1 0
>6 Months 5 5 0 1 2 2 1 3 0 0 1 3 1
Year 13 12 1 3 6 4 4 4 3 2 9 1 1
>year 14 5 9 2 8 4 2 5 4 3 5 5 4
273
APPENDIX H: ENVIRONMENTAL HYGIENE PRACTICES IN HOUSEHOLDS AS PER SOCIO-ECONOMIC STATUS
All Sinthumule Tshifhire 1 - 3 people
4 - 5 people 6+ people <10th grade
1- or 11 grade
Grade 12
Tertiary <R1000 R1000 - R2000
>R2000
All 201 121 80 53 66 82 44 51 52 51 62 68 63
prevention of insects
Cover food with cloth 175 104 71 45 53 77 38 45 48 42 52 64 52
Cover food with lid 41 10 31 11 12 18 7 8 13 13 9 14 17
Insect repellent 56 32 24 12 21 23 15 15 10 16 15 18 21
insect swatter 30 15 15 3 5 7 2 3 6 4 4 4 7
No method 1 1 0 0 1 0 0 0 0 0 1 0 0
Cover food
Yes 199 120 79 1 1 0 43 51 52 50 62 68 61
no 1 1 0 1 1 0 1 0 0 1 0 0 2
Rinse food before use
Yes 186 111 75 51 61 74 39 46 51 47 54 64 61
No 10 7 3 1 2 7 2 5 1 2 54 64 61
Drying of utensils
Clean cloth 192 113 79 51 63 78 43 47 52 48 59 67 60
Dirty towel 4 2 2 1 1 0 0 0 1 1 1 0 0
Wipe on clothing 32 16 16 3 3 10 4 7 1 3 6 5 4
other 6 3 3 1 2 3 1 1 2 2 1 3 2
washing utensils after use
yes 189 115 74 51 59 79 42 46 50 49 55 67 59
No 12 6 6 2 7 3 2 5 2 2 7 1 4
274
APPENDIX I: CONTAINER HYGIENE AS PER SOCIO-ECONOMIC STATUS
All Sinthumule Tshifhire 1 - 3 people 4 - 5 people 6+ people <10th grade 1- or 11 grade Grade 12 Tertiary <R1000 R1000 - 2000 >R2000
201 121 80 53 66 82 44 51 52 51 62 68 63
Washing container before filling
yes 115 61 54 25 39 51 21 30 34 27 34 42 34
No 14 8 6 6 4 4 4 4 2 4 9 1 4
Plastic screw open container used 93 62 31 22 29 42 19 31 26 16 38 29 23
Plastic screw open 3 2 1 0 1 2 3 0 0 0 1 1 1
Plastic screw wide mouth (open) 32 8 24 7 13 12 3 10 12 7 8 14 10
Plastic screw wide mouth (closed) 48 14 34 11 20 17 10 6 13 17 10 19 18
Container hygiene inside(open screw)
Biofilm 39 24 15 12 9 18 10 12 11 5 16 14 9
Loose particles 14 1 13 2 5 7 2 3 7 2 5 3 6
Clean 36 36 0 7 14 15 6 13 8 9 16 11 7
Container hygiene inside (Closed screw)
Biofilm 7 4 3 2 2 3 2 1 2 2 1 2 3
Loose particles 19 0 19 4 8 7 4 3 4 8 2 8 9
Clean 32 23 9 11 9 12 8 7 6 11 9 13 10
Container hygiene inside (open wide mouth)
Biofilm 10 1 9 0 2 8 3 2 3 2 2 5 3
Loose particles 10 1 9 4 3 3 2 2 4 2 4 3 3
Clean 15 8 7 3 9 3 1 5 6 3 3 8 4
Container hygiene inside (close wide mouth)
Biofilm 5 2 3 0 2 3 1 1 3 0 2 3 0
Loose particles 21 3 18 6 8 7 6 2 4 7 4 8 8
Clean 24 10 14 6 11 7 3 3 7 11 4 8 12
275
APPENDIX J: CONTAINER CLEANING METHODS AND PRIOR USE AS PER SOCIO-ECONOMIC STATUS
All Sinthumule Tshifhire 1 - 3 peopl 4 - 5 people 6+ people <10th grade 1- or 11 grade Grade 12 Tertiary <1000R R1000 – R2000 >R2000
201 121 80 53 66 82 44 51 52 51 62 68 63
Container cleaning method
Rinse outside 2 0 2 1 1 0 1 1 0 0 2 0 0
Rinse outside-out 11 7 4 1 5 5 3 4 2 2 6 3 2
Wash with soap 9 9 0 0 3 6 1 3 3 1 3 4 2
Wash with soap inside out 11 8 3 4 2 5 2 5 1 3 2 4 5
Wash with soap and sand Inside-out 102 70 32 29 34 39 24 27 26 23 34 36 28
Wash with sand inside 10 1 9 3 3 4 3 0 5 2 2 5 3
Other 29 5 24 8 10 11 4 6 7 12 7 10 12
Container prior use
Newly bought 36 9 27 3 13 20 3 10 11 12 8 14 14
Carry foodstuff 62 44 18 17 20 25 15 18 19 9 25 22 15
Carry chemicals 64 39 25 22 20 22 16 16 13 19 20 23 17
Other/ not sure 11 8 3 4 5 2 4 2 1 2 3 3 4
Place where container was found
Workplace 20 12 8 7 6 7 6 6 1 7 7 7 6
Vendors 17 13 4 5 7 5 5 6 1 5 10 4 3
Shop 27 14 13 6 7 14 5 5 8 9 5 13 9
Re-use paint container 3 1 2 0 2 1 1 0 0 2 1 0 1
Pension pay point 42 28 14 13 16 13 13 9 9 9 15 16 11
No container used 2 2 0 0 1 1 1 0 1 0 0 1 1
Gauteng 38 36 2 8 12 18 3 13 12 10 12 11 13
Donated 5 1 4 0 4 1 1 0 3 1 2 1 2
Can't remember 4 4 0 2 0 2 1 2 1 0 0 3 0
276
APPENDIX K: HOUSEHOLD WATER SOURCES AND TREATMENT AS PER SOCIO-ECONOMIC STATUS
All Sinthumule Tshifhire 1 - 3 people
4 - 5 people
6+ people
<10th grade
1- or 11 grade
Grade 12
Tertiary <R1000 R1000 - 2000
>R2000
All 201 121 80 53 66 82 44 51 52 51 62 68 63
drinking water sources
Yard standpipe 31 3 28 5 11 15 0 6 12 13 5 8 12
Communal Standpipe
54 27 27 17 12 25 16 14 17 7 16 25 13
Borehole 10 5 5 1 2 2 1 0 0 4 1 0 4
Tank 6 3 3 1 2 0 1 0 0 2 0 1 2
Spring 62 0 62 16 19 27 12 12 20 18 14 25 23
Private drilled Wells 25 0 25 6 10 9 6 8 6 5 11 8 5
River 6 0 6 1 2 3 2 1 3 0 1 4 1
Water Treatment
yes 63 41 22 21 15 27 14 13 18 18 17 24 21
No 88 71 17 24 35 29 19 29 17 20 33 27 21
Type of treatment
Bleach 24 10 14 2 5 7 2 2 6 4 4 4 6
Boiling 4 3 1 1 1 2 2 2 0 0 2 1 0
Municipality 34 20 14 12 8 14 5 9 10 10 10 12 12
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