Evaluation of the Impact and Sustainability of Hospital Water Purification Systems in Honduras Open Access

Abstract

Background: Water quality and quantity play important roles in the transmission of diarrheal disease, a leading cause of death in children under five worldwide. In Honduras, 87% of the population has access to water from improved sources, such as piped networks. However, the water supplied by improved sources may not be safe for human consumption, as an improved source does not imply clean water. Decentralized water purification systems have shown potential to provide high quality water at the institutional-level in low-income settings. Various organizations, including the General Electric Foundation (GEF), have implemented decentralized membrane ultrafiltration systems in low-income institutional settings, such as in hospitals and schools. Despite the potential of these systems to increase access to safe water, research regarding the sustainability and overall impact of this technology in low-income settings is lacking.

Objective: The objective of this study was to assess the environments that enable or limit the sustained provision and use of safe water in hospitals in Honduras.

Methods: A metric was developed to systematically assess the sustainability of safe water provision at four hospital sites using four domains of sustainability: accountability, on-site capacity, technical feasibility, and institutional engagement and support. To assess each domain, knowledge, attitudes, and practices surveys, water quality testing, and facility inspections were conducted. Data was also collected at two control hospitals without water purification systems in order to measure the impact of the GEF-donated systems.

Results: The results of the sustainability assessment showed that all intervention hospitals were vulnerable to becoming unable to sustain safe water provision. Each hospital had different strengths and challenges within the four sustainability domains. Intervention hospitals were found to have significantly cleaner water than control hospitals; however, additional benefits of the water purification systems were minimal.

Discussion: Targeted efforts must be made to increase sustainability within specific domains. Best practices from each hospital can be adopted to increase the sustainability and impact of the water purification systems in other hospitals, as well as improve future donations of water purification systems.

Table of Contents

Acknowledgements ..................................................................................................................... i
Table of Contents ...................................................................................................................... ii
List of Tables and Figures ........................................................................................................... iii
List of Acronyms ....................................................................................................................... iv

1 INTRODUCTION....................................................................................................................... 1
1.1 Problem Statement .............................................................................................................. 1
1.2 Purpose ............................................................................................................................. 3
1.3 Significance ........................................................................................................................ 4
1.4 Definitions .......................................................................................................................... 4
2 REVIEW OF THE LITERATURE .................................................................................................... 6
2.1 Worldwide Access to Safe Water............................................................................................. 6
2.2 Access to Safe Water in Honduras .......................................................................................... 9
2.3 Decentralized Water Treatment Systems in Low-Income Settings ................................................. 10
2.4 Membrane Ultrafiltration Systems in Low-Income Settings ........................................................... 13
2.5 Sustainability ...................................................................................................................... 16
2.6 General Electric Foundation: The Developing Health GloballyTM Initiative ........................................ 24
3 METHODS ............................................................................................................................. 25
3.1 Research Design .................................................................................................................. 25
3.2 Study Sites ........................................................................................................................ 26
3.3 Instrument Development ....................................................................................................... 28
3.4 Interview and Survey Data Collection Process ........................................................................... 35
3.5 Water Quality Testing Procedures ........................................................................................... 37
3.6 Data Analysis ...................................................................................................................... 43
3.7 Ethical Considerations and Confidentiality ................................................................................. 45
4 RESULTS .............................................................................................................................. 46
4.1 Demographic Data................................................................................................................ 46
4.2 Water Quality Data............................................................................................................... 48
4.3 Impact of GEF-Donated Water Purification System...................................................................... 52
4.4 Sustainability Metric Scores ................................................................................................... 56
5 DISCUSSION .......................................................................................................................... 68
5.1 Impact of GEF-Donated Water Purification System...................................................................... 68
5.2 Sustainability Metric ............................................................................................................. 72
5.3 Study Limitations ................................................................................................................. 78
6 RECOMMENDATIONS AND NEXT STEPS ....................................................................................... 80
6.1 Recommendations ................................................................................................................ 80
6.2 Next Steps ......................................................................................................................... 84
7 CONCLUSIONS ....................................................................................................................... 86

References .............................................................................................................................. 87
Appendix 1. Interview Tools ....................................................................................................... 90
Appendix 2. Sustainability Metric ................................................................................................. 123

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	water treatment low-income setting sustainability evaluation
Committee Chair / Thesis Advisor	Moe, Christine L, Emory University
Partnering Agencies	Industrial or Commercial (for-profit) organization

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