Evaluation of the Impact and Sustainability of Hospital Water Purification Systems in Honduras Pubblico
Roguski, Katherine Margaret (2013)
Published
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
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