Sustainability Evaluation of Water Filtration Systems in Honduran Hospitals to Inform The General Electric Foundation's Donation Strategy Open Access
Lie Tjauw, Samantha M. (2014)
Abstract
Background: In Honduras, 1-5% of
deaths annually are attributable to disease or injury related to
water, sanitation, and hygiene (WASH) [Moll 2007].
Although 87% of Honduras has access to an improved water source,
access to safe water is unknown and vulnerable populations
are disproportionately affected by WASH-related disease
[Pruss 2002, Pruss 2008, UN 2012]. The General
Electric Foundation (GEF) has chosen to focus on improving access
to safe water in healthcare facilities through the donation of
decentralized water filtration systems (DWFS) to four hospitals in
Honduras. A baseline sustainability evaluation conducted in
June/July 2012 found that two of the four hospitals had
environments that would enable long-term sustainability of the
DWFS. Considering the post-2015 Millennium Development
Goal agenda includes targets for the provision of safe water in
healthcare facilities, there is a need for research on
the institutional use and long-term sustainability of
DWFS in these settings [UN
2013].
Objective: To provide a
deeper understanding of challenges and opportunities related to the
sustainable access to and provision of safe water in Honduran
hospitals operating GE DWFS. Evaluation based on four
sustainability domains will inform the GEF's future water
filtration system donation
strategies.
Methodology:
A systematic mixed-methods approach was used to collect
quantitative and qualitative data in order to calculate a
sustainability score for each hospital. Scores were determined
using a refined sustainability metric developed through literature
review and field testing during the baseline study. Each hospital
was scored from 0 to 4 in four sustainability domains: on-site
capacity, technical feasibility, accountability, and institutional
engagement. Each domain contributed equally to an overall
sustainability score between 0 and
4.
Principal Findings:
Following the 2013 sustainability evaluation, three of four
hospitals demonstrated increased sustainability scores since 2012.
The remaining hospital did not exhibit a sustainable environment
for the GE DWFS. While each site was unique in context, and
exhibited variable water quality, sustainability gaps were
identified within each of the four domains for each
hospital.
Conclusion: The identification of these
sustainability gaps allows key stakeholders to understand enabling
and limiting factors for sustainable operation of DWFS in
healthcare facilities in low-resource settings. Furthermore, this
knowledge can inform actions to increase access to safe water
globally.
Table of Contents
INTRODUCTION AND BACKGROUND 1
- GENERAL ELECTRIC FOUNDATION PROJECTS 2
- BASELINE STUDY 3
- PROBLEM STATEMENT 4
- PURPOSE 4
- RESEARCH OBJECTIVES 5
- RESEARCH QUESTIONS 5
- SIGNIFICANCE STATEMENT 6
LITERATURE REVIEW 7
- GLOBAL BURDEN OF WATERBORNE DISEASE 7
- GLOBAL ACCESS TO SAFE WATER 8
- ACCESS TO SAFE WATER IN HONDURAS 12
- WATER QUALITY IN HEALTHCARE FACILITIES 13
- DECENTRALIZED WATER FILTRATION SYSTEMS 14
- SUSTAINABILITY 17
- STUDY RELEVANCE 19
METHODS 21
- RESEARCH DESIGN 21
- PROJECT SITE AND STUDY POPULATION 21
- TOOL DEVELOPMENT 22
- INTERVIEWS AND KAP SURVEYS 23
- WATER SAMPLE COLLECTION 24
- WATER QUALITY TESTING 24
- HOSPITAL FACILITY INSPECTIONS 26
- SUSTAINABILITY SCORING 26
- DATA MANAGEMENT AND ANALYSIS 29
- WATER-USE PRACTICES AND PERCEPTIONS 29
- TOTAL COLIFORMS, E. COLI, AND P. AERUGINOSA CONCENTRATION TRENDS: 2012 VS. 2013 30
- WATER QUALITY ACCORDING TO DRINKING WATER QUALITY GUIDELINES: 2012 VS. 2013 30
- SUSTAINABILITY EVALUATION 31
- HUMAN SUBJECTS AND ETHICAL CONSIDERATIONS 32
RESULTS 33
- WATER-USE PRACTICES AND PERCEPTIONS 33
- TOTAL COLIFORMS, E. COLI, AND P. AERUGINOSA CONCENTRATION TRENDS: 2012 VS 2013 36
- WATER QUALITY ACCORDING TO DRINKING WATER QUALITY GUIDELINES: 2012 VS. 2013 43
- SUSTAINABILITY EVALUATION 46
- GRACIAS 46
- LA ESPERANZA 47
- OLANCHITO 47
- SAN LORENZO 47
DISCUSSION AND CONCLUSION 64
- WATER USE PRACTICES AND PERCEPTIONS 64
- WATER QUALITY 66
- SUSTAINABILITY 67
- ON-SITE CAPACITY 68
- TECHNICAL FEASIBILITY 70
- ACCOUNTABILITY 72
- INSTITUTIONAL ENGAGEMENT 74
- OTHER INTERESTING FINDINGS - FINANCIAL BURDEN AND OPPORTUNITIES FOR COST SAVINGS 77
- OTHER INTERESTING FINDINGS - OPPORTUNITIES FOR STRATEGIC PARTNERSHIPS FOR SUSTAINABILITY 78
- STUDY STRENGTHS 80
- STUDY LIMITATIONS 80
- RECOMMENDATIONS FOR FUTURE RESEARCH 82
STUDY IMPLICATIONS AND RECOMMENDATIONS 84
- ON-SITE CAPACITY 84
- TECHNICAL FEASIBILITY 84
- ACCOUNTABILITY 85
- INSTITUTIONAL ENGAGEMENT 85
REFERENCES 88
APPENDICES 92
- APPENDIX 1: 2013 SURVEY AND INTERVIEW TOOLS (ENGLISH) 92
- APPENDIX 2: 2013 SURVEY AND INTERVIEW TOOLS (SPANISH) 151
- APPENDIX 3: 2013 SUSTAINABILITY METRIC BY DOMAIN 206
- APPENDIX 4: IRB EXEMPTION LETTER 224
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