Predicting Sustainability of Rural Hand Pumps in Northern Mozambique Open Access

Abstract

Introduction:Sub-Saharan Africa lags behind the rest of the world in expanding coverage to improved water sources, and high rates of failing hand pumps in the region are another major impediment of equitable access to a sustainable water supply. Previous studies have found that governance, the decision-making process through which water, sanitation, and hygiene committees (WASHCos) identify and resolve their own problems, is associated with hand pump functionality.

Methods: We conducted a cross-sectional study in two different districts in northern Mozambique using a mixed-methods approach to assess the association between governance, women's experience, and sustainability of rural hand pumps. Regression analyses were conducted to identify potential predictors of hand pump sustainability, as well as the categories of governance most strongly associated with sustainability. Governance was divided up into four main categories, which included responsiveness, finances, management, and accountability.

Results:Of the 143 total hand pumps assessed, 90 (63%) of them were functioning on the day of the survey. The different models measuring the association between past and current functionality with individual components of governance identified varying predictors of functionality. Overlapping components included perceived water quality (p=0.003) and WASHCo rules and regulations (p=0.04). Finances and responsiveness were found to be most strongly associated with current functionality (p=0.001); however, when controlling for all other covariates, only responsiveness was significant. Those communities with at least one functioning water point had a higher mean score (79.9) for positive women's experience score than those no functioning water points (62.7) (p=0008).

Discussion:As our models produced varying results, it is difficult to conclusively identify any specific components of governance associated with sustainability. This differed from previous CARE studies that did not control for external factors such as community location or type of pump.

Table of Contents

Acknowledgements..

Chapter 1: Literature Review..1

Introduction..1

Global Burden of Water-Related Disease..2

Hand Pumps..3

Common Types of Hand Pumps.. 4

Failure Rates of Hand Pumps in sub-Saharan Africa.. 5

Community Management of Water Supply.. 6

Water Point Sustainability.. 8

Indicators for Sustainability..10

Governance and Sustainability.. 11

Women's Experience and Sustainability.. 18

Other factors that affect Sustainability.. 19

Justification for Research.. 20

Chapter 2: Manuscript..21

A. Introduction..21

Water Supply in Mozambique..21

Water Point Sustainability..22

Governance and Sustainability..23

Women's Experience and Sustainability..24

Research Objectives..24

B. Methods..26

Research Questions and Hypothesis..26

Study Setting and Background..27

Selection Criteria..28

Research Tools..29

Data Management and Analysis..31

Statistical Analysis..32

C. Results..35

Governance and Sustainability..35

Women's Experience and Sustainability..43

Results from Semi-Structured Interviews..44

D. Discussion..47

Limitations..50

E. References..52

Chapter 3: Summary..56

Public Health Implications.. 56

Conclusions and Recommendations..57

Appendix 1: Survey Tools..59

A. GiFT (English)..60

B. GiFT (Portuguese)..64

C. IWWT (English)..68

D. IWWT (Portuguese)..71

Appendix 2: Additional Tables & Figures..74

Appendix 3: Acronyms..91

Figures and Tables

Figure 1.1 Sketches of common types of hand pumps..5

Figure 1.2: The Sustainability Chain..9

Figure 1.3 Conceptual framework for community-based management of rural water supply..9

Figure 1.4 Conceptual framework showing sustainability triangle..11

Figure 1.5 Conceptual framework of CARE research using GiFT tool..14

Figure 2.1 Political Map of Mozambique..27

Figure 2.2 Current Water Point Functionality Stratified by Year..37

Figure 2.3 Replacement Parts Needed..45

Figure A.1 Study Conceptual Framework..84

Figure A.2 Current Water Point Functionality Stratified by District..84

Figure A.3 Current Water Point Functionality Stratified by Implementer..85

Figure A.4 Current Water Point Functionality Stratified by Type of Pump..85

Figure A.5 Distribution of Number of Users per Water Point..86

Figure A.6 Distribution of Number of Water Points per Community..86

Figure A.7 Distribution of Number of times Broken per Water Point..87

Figure A.8 Distribution of Number of Total Days Broken per Water Point..87

Figure A.9 Distribution of Past Functionality..88

Figure A.10 Distribution of Responsiveness Score..88

Figure A.11 Distribution of Finance Score..89

Figure A.12 Distribution of Management Score..89

Figure A.13 Distribution of Accountability Score..90

Figure A.14 Distribution of Total Governance Score..90

Table 1.1 Results from CARE governance study in Mozambique, 2011..13

Table 1.2 Questions from GiFT for functionality and domains of governance..15

Table 2.1 Prevalence and Percentage of Functioning Hand Pumps..36

Table 2.2 Past Functionality of Hand Pumps..38

Table 2.3 Characteristics of Functionality for Water Points..38

Table 2.4 Characteristics of Governance Categories..39

Table 2.5 Results of Bivariate Analysis for Individual components of governance..40

Table 2.6 Results from Linear Regression..41

Table 2.7 Results of Logistic Regression for individual components of governance..42

Table 2.8 Results of Logistic Regression for categories of governance..43

Table 2.9 Characteristics of Women's Experience Scores..43

Table A.1 Scoring System for GiFT categories of governance..74

Table A.2 Questions from IWWT, both direct and indirect impacts..76

Table A.3 Questions and Response Frequencies from GiFT..77

Table A.4 Questions and Response Frequencies from IWWT.. 80

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	women sustainability governance hand pump water
Committee Chair / Thesis Advisor	Freeman, Matthew, Emory University
Committee Members	Tolbert, Paige, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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