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Institute of Medicine (US) Roundtable on Environmental Health Sciences, Research, and Medicine. Global Environmental Health: Research Gaps and Barriers for Providing Sustainable Water, Sanitation, and Hygiene Services: Workshop Summary. Washington (DC): National Academies Press (US); 2009.

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Global Environmental Health: Research Gaps and Barriers for Providing Sustainable Water, Sanitation, and Hygiene Services: Workshop Summary.

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10Breakout Group: Meeting Goals for Water, Sanitation, and Hygiene

With the understanding that robust discussions from all participants are difficult in an agenda-rich meeting, a final discussion continued on the third day to highlight research gaps, barriers, and challenges in providing global water sustainability. The group also noted what the workshop failed to capture and what should be included in future discussions.


The lack of a standardized mechanism to evaluate projects continues to be one of the most challenging barriers to overcome in providing sustainable water, according to some participants. Current evaluation practices monitor programmatic goals, such as the duration of the project, the number of wells, and financial goals (e.g., the number of projects funded or the amount of money dispersed). However, asserted some participants, programmatic monitoring misses the objectives of the funding: the need for safe drinking water. A better strategy would be to monitor whether interventions, activities, and programs have actually achieved their primary objectives. Participants noted that while these monitoring strategies are more difficult to implement, the monitoring of mortality and morbidity reduction in relation to water sustainability and hygiene is essential to improving sustainable water services. Mawuna Gardesey of the Delaware Division of Public Health observed that, in addition to meeting the primary objectives of supplying safe drinking water, an intervention-centered strategy will inform best practices and interventions that can be tailored to fit individual communities. For example, monitoring can provide insight into what is an effective balance between drinking water, sanitation, and hygiene interventions. However, Vincent Nathan of the City of Detroit Department of Environmental Affairs asserted that monitoring alone is not enough. The community needs to be engaged in the evaluation. He noted that while donors are primarily interested in the evaluation of programs and monetary allocation, community evaluation can provide workable knowledge for future projects and create a better sense of community ownership. In the end, Jennie Ward Robinson of the Institute for Public Health and Water Research noted that community-centered approaches coupled with intervention strategies are necessary if the global community is going to reach the Millennium Development Goals for water. She asserted that current evaluation strategies are not aligned with the goals and misguide program allocations.


Currently, some participants noted that there is a gap between research on sustainability and policy for implementing sustainable water services. The lack of evaluation and evidence-based science was identified as one of the main challenges in bridging the gap between research and policy. Nathan noted that the lack of evaluation fails to provide the facts, data, and evidence needed to further future policy, and, if there is not a commitment to remedy this situation, the policies developed will not be strategic. However, some participants noted that policy should be also community and population driven. Policy makers are ultimately moved by their constituents’ needs and demands. Ward Robinson asserted that policy actions also need to be tied to evidence-based education of the policy makers. Furthermore, any policy development needs to incorporate a three-pronged approach (research, education, and community engagement) if effective policies are to be formulated. For water services, she noted that these three approaches need to happen in parallel so that water services plans are appropriate for the community, fiscally sound, and sustainable.


A third barrier identified by members of the group was the absence of leadership at the national level. Currently, researchers and agencies are not in a position to share lessons learned and best practices in a coordinated effort owing to a lack of a national clearinghouse for water practices. A national organization could synthesize the science and create an accessible database for all agencies and nongovernmental organizations, noted some participants. With a national database, future agencies and organizations can investigate what technologies are currently working and under what conditions. This will make better use of the funds and prevent overlap (continuation) of research. Ward Robinson further suggested that the clearinghouse would also serve to coordinate the efforts of donors. Ideally, she suggested, this clearinghouse would allow for policy makers, potential donors, and experts in the field to elicit information on current interventions under way, as well as who is working in particular research areas and geographical regions. Accessing this information, she noted, will allow for substantive decisions, funding, determination of the next research project, and identification of best practices.


Some participants identified an interdisciplinary approach as a need in providing sustainable water services. The problem starts early in professionals’ training, during their education. University degree programs have strict curricula that do not allow for the multidisciplinary education needed to address these multifaceted problems, noted one participant. After graduation, the separation of disciplines continues. In most developed countries, the delivery of water and sanitation is relegated to engineers, and hygiene is overseen by public health professionals—there is not a lot of cross talk. One participant mentioned her concern that the current disconnect between disciplines in the U.S. education system is being transferred to these developing countries. We have social scientists educating communities on the value of water and engineers educating others on how to maintain the wells, but there is still no holistic approach to educating entire social groups and communities. This is problematic as groups are trying to reach target drinking water goals, noted one participant.


Communities are not monolithic around the world, yet we try to solve the world’s water problems as if they were, asserted one participant. Finding the balance between the goals of researchers and scientists with the wants of a community has been a struggle for many employed in water sustainability and can lead to a failed water intervention strategy. Sustainable water, hygiene, and sanitation may not be as highly valued in some communities as it is in the United States, noted some participants. These communities are content with their current water situation, regardless of how clean the water is or how far they must walk to retrieve it. Without a community’s desire for water programs, researchers and scientists will be unable to create a long-term sustainable water infrastructure. For example, Paul Hunter of the University of East Anglia spoke of his experience in South Africa when a community’s main priority was their desire for mobile telephone masts, while the researchers were concerned with ensuring a readily supply of potable water. These sometimes nonbasic needs took priority in the community for a variety of reasons that may not be obvious to the researcher. To remedy the situation, a commercial company was engaged to provide mobile telephone masts, which in turn created more business for them. Hunter noted that this example illustrates the need for compromise between researchers and the community. Supplying the community with what they desire (in exchange for what they need) contributes to the awareness of the importance of clean water and is supportive of program implementation. The stakeholders must work together to set up an agenda for a community, and that agenda must be based on both the goals of the researchers and the needs of the community.


A theme echoed repeatedly by participants throughout the workshop was the need to appropriately engage the community, encourage ownership of the project, and provide the education to local community members to ensure sustainability of the program. While this is a well-understood need for any successful program, it has continued to be one of the biggest challenges to overcome, noted many participants.

The problem is twofold. Developing countries and communities without financial stability are most likely to be willing to accept money or water programs from any donor offering help. Similarly, institutions are not educating the donors on best practices, in turn potentially hurting the communities more than helping. Without the proper education, donors’ decisions may not garner the expected or desired outcome, resulting in poorly utilized funds, time, and resources. Many donors require that, in exchange for funding from their company, the recipients must agree to use their technology and buy directly from them for the life of the well. This type of funding hinders the region’s efforts in creating a sustainable national utility, asserted one participant. What becomes visible too often, noted Ward Robinson, are poorly managed or maintained equipment, as training and resources for repairs may not be indigenous to the local community. Thus the education of the community and the use of local labor, skills, and resources have been identified as one of the best ways to help to create community ownership and longevity of programs. And yet funding programs are not designed with a long-term outlook, asserted Ward Robinson. Often the time frame of the program is 3–6 months, but the continuity after the funding is not considered.

One way to address this barrier is to have interdisciplinary education for community members to ensure the project’s sustainability after sponsors leave, noted one participant. This community engagement will ensure that people are equipped with the proper skill set needed to create long-term sustainability and capacity. Ward Robinson felt that too few donors are currently utilizing an existing trusted institutional system to further the educational and technical capacity of the local community. This investment in resources could be used to increase the longevity of the project, as they would be educating the youth, who would in turn educate their parents and future children.

The discussion also focused on creating an educational capacity in a country, so that citizens could implement similar water programs in other communities. This strategy would end the need for nongovernmental organizations to establish prolonged residence in the local community by shifting the power to the individual communities and in addition begin to build and strengthen a national utility. A participant gave examples of how this process is being used in some communities. Nongovernmental organizations create water resource community building groups, which work to educate key members in the community to lead the maintenance and sustainability of the project after the outside group leaves. They also work to educate community members and create regional experts who can work throughout the region as experts on water. These local water experts will help create national ownership of new program implementations. The advantage of this approach is to increase the efficiency of intervention strategies. As programs are tailored for individual communities, researchers spend large amounts of time and resources learning about individual community cultures, modifying each program to fit societal needs. By creating a national utility led by a group of educated locals, implementation time will be reduced, as the locals will already be aware and understanding of the cultural differences. They will also be able to gain community trust and create community support faster than foreign scientists and researchers, noted some participants.

Finally, many participants agreed that nongovernmental organizations are able to make large change at the community level, but they find it difficult to bring national attention or change in regard to water. Some of these countries do not have stable national governments to impede the implementation of these programs. The community by community approach is therefore most feasible. Communities are many times more stable and less volatile than many national governments. In some regions of the world, water projects have been implemented at a national level only to have the country overturned and dismantled after years of resources investment into the programs. By focusing on the community, not only does it ensure continuity of ownership of the program, but also the communities provide stability, even during a disruption of the national government.


Many times donors’ personal interest in their investment return can create barriers in the ability to develop a comprehensive, sustainable program on the national level, noted some participants. Ward Robinson commented that providing safe drinking water is a hot philanthropic effort, with many potential donors looking for opportunities to invest money in programs. However, this influx of money brings technological challenges when donors do not fund technology that can be used interchangeably. When multiple individual communities in the same region or country receive different technology, the national government is unable to provide adequate maintenance and funding for long-term sustainability. Donors need to be educated on the need to fund interchangeable technology that can operate with other products, so the national government can develop a national utility with cohesive technology, asserted one participant.

A second challenge with donors is the role of businesses in providing sustainable water services. There is a sometimes-negative stereotype of working with large, for-profit corporations that has proven to be a challenge for many nongovernmental organizations and nonprofits to overcome. Many times possible funding opportunities go untapped for fear of the negative connotation that groups believe will be used against them for working with large corporations, asserted one participant. Instead, there is a need to educate corporations on their ability to provide social influence and to create a return in funding sustainable communities. Participants voiced the need to bring donors together in dialogue with agencies in order to discover the philanthropic and business opportunities that water sustainability projects can supply. By including donors in the dialogue and educating them on the needs of communities, some participants believe that donors would become more tolerant for the program designs, nuances, and ad hoc requests that emerge while executing a project.

Copyright © 2009, National Academy of Sciences.
Bookshelf ID: NBK50778


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