The objective of this study is to evaluate the effects of water safety plans (WSPs) in rural Ghana. The investigators aim to evaluate the effects of WSPs on water supply system infrastructure, water availability and reliability, water quality, consumer perceptions, water service provider management and financial sustainability, climate resilience, equity, and consumer health.
Much of the global population is exposed to contaminated drinking water. In piped systems, it is often easier to mitigate at the water supplier level where it can be centrally managed. A water safety plan (WSP) is a holistic tool for proactively ensuring the safety of drinking water supplies from source to tap, and the World Health Organization (WHO) recommends this systematic risk assessment and preventive management approach for water systems. While application of WSPs has spread, systematic evidence for their implementation and effectiveness in improving water quality and health is limited, particularly in low-resource settings. The objective of this study is to evaluate the impact of WSPs on water supply system infrastructure, water availability and reliability, water quality, consumer perceptions, water service provider management and financial sustainability, climate resilience, equity, and consumer health. The investigators will use a randomized controlled trial across 92 piped water supply systems serving small towns and rural areas in Ghana to test the effectiveness of WSPs. The investigators will collect data at baseline before the intervention is implemented, and at endline approximately 2 years after implementation begins. The investigators will also conduct a process evaluation of the WSP implementation quality.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
4,500
Water safety plans will be implemented at the water system level as a holistic tool for ensuring the safety of drinking water supplies from source to tap. World Health Organization guidance will be followed for implementation and recommended water safety planning steps will be followed such as assembling a WSP Team, describing the water supply, hazard identification and risk assessment, developing and implementing an incremental improvement plan, monitoring control measures to verify the effectiveness of the WSP, and continuously documenting, reviewing, and improving WSP implementation.
The Aquaya Institute
Accra, Ghana
Free chlorine residue in water at point of collection (water quality impacts)
Free chlorine residue in water at point of collection (public standpipes and private taps) at or above target level of 0.2 mg/L, and at or above detectable level of 0.1 mg/L
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
E. coli in water at point of collection (water quality impacts)
E. coli in water at point of collection (binary and categorical)
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Total coliform in water at point of collection (water quality impacts)
Total coliform in water at point of collection (binary)
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Turbidity of water at point of collection (water quality impacts)
Turbidity measured in NTU in water at point of collection
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Reliability/availability of water (water supply impacts)
Reliability/availability of water based on (1) service provider documented interruptions, and (2) consumer reported service interruptions
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Consumer satisfaction (consumer perception impacts)
Household respondent satisfaction with water supplier. They will be considered satisfied if they report they are either satisfied or very satisfied with the water supplier. They will be considered dissatisfied if they report they are either dissatisfied or very dissatisfied with the water supplier.
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Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Household use of enrolled piped water system for drinking (consumer perception impacts)
Household use of enrolled piped water system for drinking (binary).
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Households perceive water quality issues with piped water system (consumer perception impacts)
Household respondents report water quality issues with the taste, odor, or appearance of supplied water.
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Number of complaints (consumer perception impacts)
Number of complaints regarding the service or quality of water. This will be measured based on (1) household self-reporting, and (2) water system reports or records.
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Prevalence of diarrhea (health impacts)
Prevalence of reported diarrhea in the past two weeks. Diarrhea is defined as 3 or more loose or watery stools within 24 hours. Measured for a household's youngest child \<5 years old, and any household member showing symptoms.
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Blood in stool (health impacts)
Prevalence of reported blood in stool in the past two weeks. Measured for a household's youngest child \<5 years old, and any household member showing symptoms.
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Prevalence of severe diarrhea (health impacts)
Prevalence of reported severe diarrhea in the past two weeks. Defined as having a fever and either diarrhea or blood in stool. Measured for a household's youngest child \<5 years old.
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Prevalence of acute respiratory infection (health impacts)
Prevalence of reported severe or non-severe acute respiratory infection (ARI) in the past two weeks. A severe ARI is defined as having a fever and either a cough or difficulty breathing. A non-severe ARI is defined as having a cough or difficulty breathing. Measured for a household's youngest child \<5 years old.
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Number of clinic visits for water-related illness (health impacts)
Clinical visits will be assessed based on (1) the number of clinic visits reported by households for diarrhea-related illness, and (2) records for the number of cases of water-related illness in patients who visited healthcare facilities serving the included communities.
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
E. coli in stored water at point of consumption (water quality impacts)
E. coli in stored household water at point of consumption (binary and categorical)
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Total coliform in stored water at point of consumption (water quality impacts)
Total coliform in stored household water at point of consumption (binary)
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Free chlorine residue in stored water at point of consumption (water quality impacts)
Free chlorine residue in stored household water at point of consumption at or above target level of 0.2 mg/L, and at or above detectable level of 0.1 mg/L
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)
Total chlorine residue in stored water at point of consumption (water quality impacts)
Total chlorine residue in stored household water at point of consumption at or above target level of 0.2 mg/L, and at or above detectable level of 0.1 mg/L
Time frame: Baseline (before intervention), Endline (approximately 24-months after the start of the intervention)