Sustainability Evaluation of Water Filtration Systems in Honduran Hospitals to Inform The General Electric Foundation's Donation Strategy 公开

Lie Tjauw, Samantha M. (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/gm80hv46x?locale=zh
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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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