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Community-led total sanitation (CLTS) is increasingly promoted globally as an innovative approach to addressing the sanitation challenge in developing countries, especially in the rural areas where access to sanitation remains poor. However, a significant challenge in CLTS is poor management of faecal sludge when pits are full. In this regard, composting toilets offer a potentially viable and ecologically sound method for effective and efficient faecal sludge management, by providing fertilisers that act as soil conditioners, and ultimately contribute to clean environment, food security, good health, and poverty alleviation. Despite these advantages, there is limited knowledge on why and how composting toilets can be successfully integrated into CLTS initiatives. In this paper, we use the case of Ghana to demonstrate that integrating composting toilets into the CLTS approach is a feasible option for sustainable and environmentally friendly faecal sludge management in rural areas where agriculture is the predominant livelihood activity.

Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low- and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool. HIGHLIGHTS We present comparison scores of the Household Water Insecurity Experiences (HWISE) scale, a novel household water insecurity index validated for use in low- and middle-income countries.; These scores can aid interpretation of future implementation of the HWISE scale.; The HWISE scale should still be evaluated in new contexts, such as high-income settings.

Compounding systems of marginalization differentiate and shape water-related risks. Yet, quantitative water security scholarship rarely assesses such risks through intersectionality, a paradigm that conceptualizes and examines racial, gendered, class, and other oppressions as interdependent. Using an intersectionality approach, we analyze the relationships between household head gender and self-reported socio-economic status, and water affordability (proportion of monthly income spent on water) and water insecurity (a composite measure of 11 self-reported experiences) for over 4000 households across 18 low- and middle-income countries in Central and South America, Africa, and Asia. Interaction terms and composite categorical variables were included in regression models, adjusting for putative confounders. Among households with a high socio-economic status, the proportion of monthly income spent on water differed by household head gender. In contrast, greater household water insecurity was associated with lower socio-economic status and did not meaningfully vary by the gender of the household head. We contextualize and interpret these experiences through larger systems of power and privilege. Overall, our results provide evidence of broad intersectional patterns from diverse sites, while indicating that their nature and magnitude depend on local contexts. Through a critical reflection on the study’s value and limitations, including the operationalization of social contexts across different sites, we propose methodological approaches to advance multi-sited and quantitative intersectional research on water affordability and water insecurity. These approaches include developing scale-appropriate models, analyzing complementarities and differences between site-specific and multi-sited data, collecting data on gendered power relations, and measuring the impacts of household water insecurity.

The novel coronavirus disease (COVID-19) pandemic is having a significant global impact on livelihoods, health, and general well-being. This policy brief argues that in low-income countries (LICs) where water, sanitation, and hygiene (WASH) insecurity is widespread and closely entangled with poverty and other vulnerabilities, COVID-19 will have a particularly devastating impact on women and girls because they bear the disproportionate burden of water collection, sanitation, hygiene, and family welfare ‒ responsibilities embedded in longstanding sociocultural norms. WASH insecurity refers to the physical and relational inequities in WASH access. Using three pathways ‒ reproductive and perinatal health, cultural norms and the risk of COVID-19 infections, and physical and mental health ‒ we discuss how WASH insecurity will worsen the impact of COVID-19 on women and girls in LICs.

The COVID-19 pandemic raises questions about the effectiveness of urban planning practice in Africa and offers an opportunity to reflect on more constructive protocols for planning that can promote...

COVID-19 has brought global attention to the critical role of water in managing infectious outbreaks. Although Sub-Saharan Africa could become a COVID-19 hotspot, some are optimistic that given the...

This study examines local news reporting about the Flint water crisis. The analysis is based on in-depth interviews with local reporters to explore journalistic practices and perceptions of the cri...

The reflexive turn in sociology and across much of the social sciences has brought a central focus on the “self” within research encounters. Within this context, qualitative researchers are required to highlight how their positionality shapes their research experience. In this article, we interrogate how our own personal experiences as native Ghanaians conducting research at home and away from home in two different African countries—Ghana and Malawi—shaped our research positionality. We use the framework of credibility and approachability and develop new categories such as the eager learner. We show how our performed behaviors and perceived characteristics enabled and constrained our access to research participants and information. The analysis contributes to the research methods literature by highlighting the fieldwork encounter as a site of shifting, negotiated, and fluid positionalities for both fully insiders and fully outsiders.

Water insecurity is a critical public-health challenge in Africa's urban informal settlements, where most of the population often lacks access to household taps. In these settings, water fetching is disproportionately performed by women. While water fetching is physically laborious and exposes women to multiple risks, the water-insecurity literature has predominantly focused on household experiences, ignoring women's water-collection journeys. This paper uses the water journey as a window into the embodied dimensions of water insecurity. Combining theoretical insights from embodiment, embodied political ecology of health, and time geographies, we use video-recorded walking interviews to analyze women's everyday water journeys in Ntopwa, an urban informal settlement in Blantyre, Malawi, from initial decision making through exposure to water-fetching risks and household practices regarding use and storage. We identify three principal sources of environmental risk- terrain, built environment, and human behavior-that present challenges for water collectors. Using the walking interview as a heuristic, we show how the seemingly simple practice of water fetching is compounded by complex decision making, constant spatiotemporal trade-offs, and exposure to diverse risks, all of which have embodied health consequences. Based on our findings, we conclude that interventions seeking to improve household water insecurity must consider the embodied effects of water-fetching journeys. This study also provides methodological insights into using walking interviews and videos for water and health research.

In Sub-Saharan Africa, only 35% of the urban population has piped water on premises despite the economic (time savings) and public health benefits that household taps offer. In the urban informal settlements, even fewer people own household taps. However, while there is extensive literature on everyday urban water insecurity in the region, far less attention has focused on whether the urban poor are interested in private taps, and if so, what service attributes are important to them. We implemented a choice experiment in Nima, an urban settlement in Accra, Ghana, to investigate community preferences and willingness to pay (WTP) for household taps. We used a comprehensive set of system attributes including days of service, service hours, water pressure, water quality, connection fees, monthly payment, and management, an attribute very few WTP studies have explored. Results from the choice experiment show that residents are more sensitive to time (not day) of service delivery, quality of water, connection fees, and monthly water bills. Households had no preference between a 24-h supply and 12-h supply during the day. Households preferred Accra Metropolitan Assembly (AMA) to Ghana Water Company Limited (GWCL) as the service provider and were willing to pay more for a system managed by AMA, an indication of declining trust in GWCL. The findings provide valuable information that policymakers and water utilities can use to assess the feasibility and cost effectiveness of extending household taps to poor urban settlements.

This study examines the adoption of latrines provided as part of reconstruction efforts after the 2004 tsunami in India. Primary data from 274 households encompassing 1154 individuals were collected from 14 villages. GLM and GLMM tests indicate that sex (more females adopted than males) is a statistically significant factor in latrine adoption (p = 0.046 and p = 0.005, respectively), while income, education, and male age cohorts were significant only in the GLM model. Regression analyses show that six social and demographic variables are somewhat predictive of latrine usage (R2 = 0.123). Thus, while quantitative methods provided a contextual summation, qualitative methods ultimately explained why individuals chose to adopt or abandon the latrines. Interviews (n = 76) and focus group discussions (n = 14) revealed that latrine adoption is influenced by cultural conceptualizations of purity, pollution, and space. For example, conceptualizations of purity and pollution led some households to deem latrines as profane and thus a barrier to the entry of gods, while spatial constraints forced others to convert latrine space to other beneficial uses (e.g., puja room and storage area). Finally, the cost of pumping septic tanks and shared infrastructure arose as barriers to latrine adoption. These barriers underscore the importance of economics as well as community demand, capacity, and cohesion in latrine adoption.

While providing drinking water on premises to all citizens in urban areas may be desirable, economic and institutional challenges coupled with poverty, insecure tenure, and other barriers prevent many water utilities from providing private taps to all households. To meet growing water demand and fill gaps in service delivery, alternative forms of public water service provision are critical. We implemented a choice experiment in Nima-Maamobi, a poor, underserved urban settlement in Accra, Ghana, to investigate household preferences for public standpipes based on the basic and limited water service categories under the WHO/UNICEF Joint Monitoring Programme's new water ladder. We also elicited local preferences for potential service administrators of the standpipes. Choice responses provided by 344 respondents were analyzed using a generalized multinomial logit model. Households were willing to pay up to US$1.25 for a 20-liter bucket of safe drinkable water, which is consistent with the average household water expenditure in the study site. Households spend at least 22% of their monthly income on water. Households' willingness to pay varied according to alternative levels of accessibility, availability, and quality of water services. Households showed strong preferences for community-based committees and nongovernmental organizations over the current water utility and the municipal assembly. The policy implications of the findings are discussed.

In urban slums – home to approximately 1 billion people worldwide - access to clean drinking water is woefully inadequate despite the United Nations' declaration that access to safe water is a fundamental human right. Households in slums are frequently forced to rely on multiple drinking water sources to meet their needs. Numerous factors influence choice of water source, including water quality, availability, reliability, and affordability. These factors are not temporally static, but instead vary over multiple timescales (from sub-daily changes to annual changes and beyond) in response to changes in the water source itself and changes in the household's ability to use that source. For example, the cost of water can may change over time in response to water availability (e.g. rainy season versus dry season) and a slum household's ability to pay for water may change over time in response to changes in household income. However, existing national and global monitoring of safe water access, including Sustainable Development Goal 6, overlook these temporal dynamics of water access, quality and health risk in slums. This paper proposes a research agenda for exploring temporal changes in drinking water access and quality in urban slums and their potential influence on health risk. It argues that in the design of research studies, policy interventions, and drinking water monitoring aimed at improving access and health in urban slums, temporal dynamics should be considered over at least three interlinked time scales: short-term (from sub-daily to week-to-week), medium-term (from month-to-month to season-to-season) and long-term (from year-to-year). The paper concludes with recommendations for future research on temporal dynamics of drinking water and health in slums.

The call for deliberate transformational adaptation (TA) has increased over the last decade. However, a challenge many planners face is the lack of clarity on the norms and principles for designing...

Water sharing between households could crucially mitigate short‐term household water shortages, yet it is a vastly understudied phenomenon. Here we use comparative survey data from eight sites in seven sub‐Saharan African countries (Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Malawi, Nigeria, and Uganda) to answer three questions: With whom do households share water? What is expected in return? And what roles do need and affordability play in shaping those transfers? We find that water is shared predominantly between neighbors, that transfers are more frequent when water is less available and less affordable, and that most sharing occurs with no expectation of direct payback. These findings identify water sharing, as a form of generalized reciprocity, to be a basic and consistent household coping strategy against shortages and unaffordability of water in sub‐Saharan Africa.

Safe and secure water is a cornerstone of modern life in the global North. This article critically examines a set of prevalent myths about household water in high-income countries, with a focus on Canada and the United States. Taking a relational approach, we argue that household water insecurity is a product of institutionalized structures and power, manifests unevenly through space and time, and is reproduced in places we tend to assume are the most water-secure in the world. We first briefly introduce "modern water" and the modern infrastructural ideal, a highly influential set of ideas that have shaped household water provision and infrastructure development over the past two centuries. Against this backdrop, we consolidate evidence to disrupt a set of narratives about water in high-income countries: the notion that water access is universal, clean, affordable, trustworthy, and uniformly or equitably governed. We identify five thematic areas of future research to delineate an agenda for advancing scholarship and action-including challenges of legal and regulatory regimes, the housing-water nexus, water affordability, and water quality and contamination. Data gaps underpin the experiences of household water insecurity. Taken together, our review of water security for households in high-income countries provides a conceptual map to direct critical research in this area for the coming years. This article is categorized under: Human Water > Human Water Peter Wall Institute for Advanced Study, University of British Columbia; PLUS Alliance; Texas AM University; U.S. National Science FoundationNational Science Foundation (NSF) [BCS-17759972] Peter Wall Institute for Advanced Study, University of British Columbia; PLUS Alliance; Texas A&M University; U.S. National Science Foundation, Grant/Award Number: BCS-17759972

Background The use of mHealth by primary health care providers is a unique opportunity to improve maternal and child health in Sub-Saharan Africa. However, few studies have examined the effects of primary health care providers’ knowledge and attitudes of mHealth for maternal and child health promotion in low-resource settings. Therefore, this study assesses the knowledge and attitudes of primary health care providers on the use of mobile technologies such as internet-enabled smartphones for maternal and child health services. Methods We used data from a cross-sectional study of seven urban local government areas in Lagos, Nigeria. A total of 518 primary health care providers were surveyed for information on the use of mobile technologies, attitudes, and actual use of mobile technologies for maternal and child health services. Data were analyzed using descriptive and multivariable linear and logistic regression models. Results Our study showed that smartphone ownership is not a predictor of high mHealth knowledge; however, having an internet-enabled smart phone was a strong predictor of higher knowledge of mHealth (regression coefficient, ß=1.20, 95% confidence interval, CI=0.61-1.79) among primary health care providers. Owning a smartphone (ß=1.00, 95% CI=0.12-1.89) and having internet-enabled phone (ß=1.14, 95% CI=0.18-2.10) were both predictors of positive mHealth attitude. Primary health care providers with higher scores on mHealth knowledge were 1.32 times more likely to use mHealth for maternal and child health services. Similarly, those with positive attitude towards mHealth were 1.15 times more likely to use mobile technology for maternal and child health services. Conclusion The results suggest the use of mHealth tools by primary health care providers to render maternal and child health services is affected by their knowledge and attitude towards mHealth. Interventions that focus on increasing mobile technologies with internet enabled devices like smartphones are needed to improve knowledge, attitudes, and use of mHealth in maternal and child health services.

Numerous studies have measured the benefits of community participation in promoting equity and efficiency in the water service-provisioning sector. However, few have focused on factors which affect functionality in community operated water schemes in urban centers. The purpose of this study is to fill this gap in knowledge. Using qualitative data gathered through focus group discussions and employing constant comparative analytic techniques this study identify four unique factors which affect functionality in community operated water schemes in Kisumu, an urban area in Kenya. The following factors seem to influence this process: (1) clannism; (2) colonial planning/zoning laws; (3) physical/geographical constraints; and (4) population increase/community fatigue. Three policy suggestions are made which can be adopted to address these impediments. One, feasibility studies should precede the execution of most future urban-based community operated water schemes in the developing world. Two, funding agencies should focus on developing strategies to collaborate with the communities upon the completion of the projects. Third, managing community urban water systems requires adequate integration and coordination between the beneficiary community and city planners on issues of land use.

Much of the literature on gender dimensions of community-based water governance focuses on irrigation systems in rural areas. Largely overlooked is how gender dynamics influence participation in community-based urban water governance systems. To address this gap, we use insights from Feminist Political Ecology (FPE) to examine whether and how community-based governance of drinking water in an urban context leads to (in)equitable gender participation and decision making. Using household surveys (n = 415), key informant interviews (n = 19), focus-group discussions (n = 14), we explore gender dynamics and power relations underpinning participation, decision making processes, and employment and benefit sharing arrangements among Water User Associations (WUAs) in the urban informal settlements of Lilongwe, Malawi. We find that WUAs do not guarantee equitable gender participation. Rather, inequitable participation is simply reified through: (1) gendered representation in WUA structures; (2) socio-cultural practices and women’s self-exclusion; and (3) community micro-politics and power relations. Our findings contradict the notion that community-based governance of water leads to equitable participation and empowerment of women. The policy implications are that without systematic efforts to incorporate women’s needs, interests, and voices, so-called participatory approaches to water governance will only serve to suppress women’s agency and reinforce existing gender-based inequalities. Future work will explore the pathways to women’s leadership in the WUAs and interrogate how women on the board and executive committees navigate their way up the hierarchy, their experiences in a male-dominated water governance scheme and their recommendations for how WUAs can improve women’s participation.

Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures moderated the relationships between water insecurity and both food insecurity and perceived stress. Using tobit mixed effects regression models, we observed a positive association between multiple measures of water expenditures and a household water insecurity score, controlling for demographic characteristics and accounting for clustering within neighborhoods and study sites. The positive relationships between water expenditures and water insecurity persisted even when adjusted for income, while income was independently negatively associated with water insecurity. Water expenditures were also positively associated with food insecurity and perceived stress. These results underscore the complex relationships between water insecurity, food insecurity, and perceived stress and suggest that water infrastructure interventions that increase water costs to households without anti-poverty and income generation interventions will likely exacerbate experiences of household water insecurity, especially for the lowest-income households.

The failure of the conventional public and private (market-based) water policies to improve urban water access in the global South has prompted growing interest in alternative models such as community–state co-production. However, there is little evidence of whether co-production can improve water service delivery in the informal settlements of sub-Saharan Africa where a disproportionately high percentage of the urban poor lives. This paper uses household surveys, key informant interviews, and focus groups to examine the impact of co-production on household water access and service delivery in the informal settlements of Lilongwe, Malawi. Co-production increased water accessibility, reduced the cost of water, increased the number of community water kiosks, and resulted in more effective financial management and accountability. However, challenges related to poor infrastructure and limited community capacity threaten the long-term sustainability of the co-production model. Urban informal residents lamented worsening water-supply interruptions and longer waiting times after co-production, challenges that require state intervention.

Although decades of research show long-duration pigeon peas (PPs) as a best-bet technology that enhances nutrition, soil fertility, crop diversification, food security, climate-change resilience, agroecological sustainability, and incomes of resource-poor smallholder farmers in Saharan Africa (SSA), PP adoption remains low. This exploratory qualitative study examines obstacles to PP adoption and their relative importance, strategies used to protect PPs from livestock damage, and the conditions that shape the emergence and effectiveness of Community Based Livestock Management (CBLM) arrangements to prevent PP damage. We conducted focus group discussions, participatory rural appraisal (PRA), and key-informant interviews in five communities at different levels and duration of PP adoption, and used theoretical insights from agrarian political economy. Livestock damage was the biggest obstacle to PP growing in new PP sites; poor markets and production factors dominated in the established sites. Individual crop-protection strategies were often time-consuming, costly, and/or ineffective. While chief-based livestock-management systems protected all crops satisfactorily during the rainy season, they were insufficient to protect PPs during the dry season. CBLM arrangements controlled livestock damage and protected PP relatively effectively throughout the year. Implemented only at the relatively established PP-growing sites, CBLM arrangements were most effective at the site (Mpokwa) where PP prices were good and markets reliable, PP was the top or major cash crop, PP growers were powerful and in the majority, and institutions pre-existed for use in CBLM. The findings lead to the following hypothesis: smallholder farmers are likely to invest time and energy in collective livestock-management approaches to prevent damage to pigeon peas when expected economic benefits of adoption exceed perceived costs for most growers, mediated by socioeconomic differentiation and power relations among major stakeholders. Future research should empirically examine determinants of CBLM emergence for PP protection and scale-up.

Poor access to potable water remains one of the most troubling challenges in Sub-Saharan Africa’s informal settlements (or slums) where majority of the poor and vulnerable urban population lives. While prior research shows significant disparities in water access between urban and rural areas, little is known about intra-urban inequalities and whether they are influenced by household socio-economic status. This paper draws from household surveys in three urban informal settlements in Lilongwe, Malawi, to explore intra-urban differences in water access based on water source, volume of water per capita, total time/day spent fetching water, and affordability of primary water source. It first compares the proportion of respondents that have access to water based on Malawi’s (national) and the United Nations and World Health Organization’s (international) minimum standards. It then uses linear and logistic regressions to examine socio-economic inequalities in water access. The results show inconsistencies in the proportion of households that satisfy Malawi versus the United Nations and World Health Organization minimum water-access standards. Household socio-economic status (SES) significantly influenced water access, underscoring the need for pro-poor water policies that recognize that even among households in predominantly poor and under-resourced urban settings, significant socio-economic differences underlie inequalities in water access.

In Ghana, chieftaincy institutions act as custodians for about 80% of the total land area, and are responsible for leasing or allocating land while official planning institutions determine and manage its use. Yet, the extent to which chieftaincy institutions impede or contribute to sustainable urban land use planning in Ghana has received limited research attention. The scholarship on urban land use planning in Ghana has instead focused largely on rapid urbanisation, limited personnel and logistical capacity of planning institutions, and mainstream political interference. This paper addresses this gap by examining the chieftaincy-land use planning nexus in the Yendi municipality, Ghana. It explores the extent to which chieftaincy institutions limit or support sustainable urban land use planning in the municipality. Household and physical surveys, expert interviews, telephone conversations, and document reviews were used. Findings indicate that while chieftaincy's role as custodian of land is central to land development, it has assumed the role of planning institutions in terms of land use determination and management. Negative perception of planning officials among residents has also overshadowed the visibility of professional planning practice in the municipality, contributing to poor land use planning. Residents continue to use chieftaincy institutions and other traditional approaches rather than formal planning agencies because the former is convenient, more effective, and yields rapid decisions. Further research is needed to explore whether land use planning under chieftaincy institutions leads to positive social and environmental outcomes.

Over 70% of Malawi’s urban population lives in informal settlements, where households regularly face chronic water insecurity. This article utilizes mixed methods – household surveys (N = 645), field observations, focus groups and interviews – to examine household water insecurity in three urban informal settlements of Lilongwe, Malawi’s capital and largest city. The study finds that water insecurity arises from overdependence on communal water kiosks which are insufficient in number, have high nonfunctional rates, are prone to vandalism, and provide water irregularly; lack of alternative improved water sources; and a significant time burden due to long waiting times and multiple trips to water sources. The findings underscore why water insecurity in Africa’s urban informal settlements deserves urgent policy attention.

Objectives Over half of the world's population (4 billion people) experience severe water scarcity at least one month per year, while half a billion people experience severe water scarcity throughout the year. Despite progress from national and global interventions, a staggering proportion of the Global South remains water insecure. Rapid urban growth and associated demographic changes, climate change, and governance failure have also fostered the growth and expansion of urban informal settlements and slums where widespread poverty and environmental hazards exacerbate the impact of water insecurity on health. This article reflects on the interactions between water insecurity and urban poverty in the Global South across four categories of health outcomes: gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness. These examples highlight the mechanisms through which urban poverty exacerbates the adverse health effects of water insecurity. Methods The four selected health outcomes were chosen a priori to represent two communicable conditions with well-developed literatures, and two noncommunicable conditions with newer literatures that have emerged over the last decade. We conducted a narrative literature review of scholarly and gray literature appearing between January 2000 and April 2019 using several online scholarly databases. Results Gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness all exemplified the relationship between water insecurity and urban poverty through human biological pathways. For each of the four health categories, we identified frontiers for human biology research contributions to the water-poverty-health nexus. Conclusions We discuss our findings in the context of three crosscutting themes that merit innovative research approaches: stressor interactions and trade-offs, exposure thresholds, and intervention efficacy. We reiterate that the global burden of disease associated with water insecurity cannot be addressed in isolation from efforts to alleviate extreme poverty.

The vast majority of sub-Saharan Africa’s current urban population lives in slums (i.e. informal settlements) where inadequate access to safe water and basic sanitation remains a serious public health challenge. This chapter draws on field observations from Malawi, Kenya, Ghana, and Nigeria, and existing literature to highlight general trends and emerging discussions on the water–health nexus in urban slums of sub-Saharan Africa. Specifically, it reviews: 1) the urban ecology of slums in sub-Saharan Africa to draw attention to the features that compound the health consequences of drinking water scarcity; 2) water access in slums, including progress and major challenges; 3) underlying causes, major pathways, and health implications of water contamination; and 4) the role of sachet water as an example of an emerging primary drinking source. This chapter concludes by highlighting scholarly gaps and opportunities for future research at the interface of the urban–water–health nexus in urban slums of Africa, all in the context of continuing population growth and rapid urbanization.

Although there is a large and growing literature on anticipated climate change impacts on health, we know very little about the linkages between differentiated vulnerabilities to climate extremes and adverse physical and mental health outcomes. In this paper, we examine how recurrent flooding interacts with gendered vulnerability, social differentiation, and place-related historical and structural processes to produce unequal physical and mental health outcomes. We situated the study in Old Fadama, Ghana, using a Photovoice approach (n = 20) and theoretical concepts from political ecologies of health and feminist political ecology. Overall, the study revealed several adverse physical and mental health impacts of flooding, with vulnerability differentiated based particularly on gender and age, but also housing, class, and income. Our findings suggest the need for greater attentiveness to social differentiation in scholarship involving political ecologies of health. The paper builds on the health and place literature by linking the social and contextual to the medical.

Global drinking water monitoring programmes and studies on water quality in urban slums often overlook short-term temporal changes in water quality and health risks. The aim of this study was to quantify daily changes in household water access and quality in an urban slum in Malawi using a mixed-method approach. Household drinking water samples (n = 371) were collected and monitored for E. coli in tandem with a water access questionnaire (n = 481). E. coli concentrations in household drinking water changed daily, and no household had drinking water that was completely safe to drink every day. Seasonal changes in drinking water availability, intermittent supply, limited opening hours, and frequent breakdown of public water points contributed to poor access. Households relied on multiple water sources and regularly switched between sources to meet daily water needs. There were generally similar E. coli levels in water samples considered safe and unsafe by residents. This study provides the first empirical evidence that water quality, water access, and related health risks in urban slums change at much finer (daily) temporal scales than is conventionally monitored and reported globally. Our findings underscore that to advance progress towards Sustainable Development Goal (SDG) Target 6.1, it is necessary for global water monitoring initiatives to consider short-term changes in access and quality.

Water sharing offers insight into the everyday and, at times, invisible ties that bind people and households with water and to one another. Water sharing can take many forms, including so-called “pure gifts,” balanced exchanges, and negative reciprocity. In this paper, we examine water sharing between households as a culturally-embedded practice that may be both need-based and symbolically meaningful. Drawing on a wide-ranging review of diverse literatures, we describe how households practice water sharing cross-culturally in the context of four livelihood strategies (hunter-gatherer, pastoralist, agricultural, and urban). We then explore how cross-cutting material conditions (risks and costs/benefits, infrastructure and technologies), socio-economic processes (social and political power, water entitlements, ethnicity and gender, territorial sovereignty), and cultural norms (moral economies of water, water ontologies, and religious beliefs) shape water sharing practices. Finally, we identify five new directions for future research on water sharing: conceptualization of water sharing; exploitation and status accumulation through water sharing, biocultural approaches to the health risks and benefits of water sharing, cultural meanings and socio-economic values of waters shared; and water sharing as a way to enact resistance and build alternative economies.

The relative significance of indicators and determinants of health is important for local public health workers and planners. Of similar importance is a method for combining and evaluating such markers. We used a recently developed index, the Urban Health Index (UHI), to examine the impact of environmental variables on the overall health of cities. We used the UHI to rank 57 of the world&rsquo, s largest cities (based on population size) in low- and middle-income countries. We examined nine variables in various combinations that were available from the Demographic and Health Surveys conducted in these countries. When arranged in ascending order, the distribution of UHIs follows the previously described pattern of gradual linear increase, with departures at each tail. The rank order of cities did not change materially with the omission of variables about women&rsquo, s health knowledge or childhood vaccinations. Omission of environmental variables (a central water supply piped into homes, improved sanitation, and indoor solid fuel use) altered the rank order considerably. The data suggest that environmental indicators, measures of key household level risk to health, may play a vital role in the overall health of urban communities.

Traditionally, urbanization is hailed as an important force for socio-economic development of countries. In fact, recent research on Africa suggests that urbanization has the potential to stimulate socio-economic development. Yet, many African countries experiencing rapid urban growth continue to bear a disproportionate amount of the costs associated with urbanization (e.g., increased urban poverty, and energy crisis among others). This is in sharp contradiction to the popular notion that urbanization is a stimulus for socio-economic development. Using Ghana as a case study, this chapter discusses the extent to which rapid urbanization influences power supply and the implications on socio-economic development. The chapter focuses on four issues: (1) the history of power and urbanization in Ghana; (2) the influence of urbanization on power crisis in Ghana; (3) the socio-economic implications of urbanization-induced power crisis; and (4) the policies available in addressing the power crisis. Recommendations to address the ever-growing demand for electrical power are proffered

We examine the performance of water user associations (WUAs) and the role of actors, power relations, socio-institutional dynamics, and context in supplying water to poor urban and peri-urban neighborhoods of Malawi’s two major cities. Using a preliminary survey, key-informant interviews, focus groups, secondary data, and insights from the community-based natural resources management (CBNRM) literature and common-pool resources (CPR) theory, we argue that while a business-based WUA model can enhance water supply and access, the urban/peri-urban and historical context alters the nature of water and social actors and power relations involved, causing tradeoffs between water-supply and social goals of ownership, participation, and empowerment. The ensuing tradeoffs demonstrate that water supply to the urban/peri-urban landscape through community-based initiatives require flexibility in CBNRM expectations.

Lack of access to potable water and good sanitation is still one of the most challenging public health concerns of the twenty-first century despite steady progress over recent decades. Almost a billion people globally lack access to safe water; over two billion live without adequate sanitation facilities. The challenge is even more daunting for Sub-Saharan Africa where coverage levels for both potable water and sanitation remain critically low. The urgent need to address the issue calls for adequate understanding of the socio-economic dimensions. Using the 2008 Ghana Demographic and Health Survey, we investigated the socio-economic and demographic factors associated with access to potable water and improved sanitation facilities. Our generalized linear models reveal that income, education, household size, and region are significant predictors of improved water and sanitation access. Our discussion and conclusion sections highlight the implications of the study results for water policy formulation and implementation in Ghana, and broadly for other developing countries.

International audience; For the next decade, the global water crisis remains the risk of highest concern, and ranks ahead of climate change, extreme weather events, food crises and social instability. Across the globe, nearly one in ten people is without access to an improved drinking water source. Least Developed Countries (LDCs) especially in sub-Saharan Africa (SSA) are the most affected, having disproportionately more of the global population without access to clean water than other major regions. Population growth, changing lifestyles, increasing pollution and accelerating urbanization will continue to widen the gap between the demand for water and available supply especially in urban areas, and disproportionately affect informal settlements, where the majority of SSA's urban population resides. Distribution and allocation of water will be affected by climate-induced water stresses, poor institutions, ineffective governance, and weak political will to address scarcity and mediate uncertainties in future supply. While attempts have been made by many scientists to examine different dimensions of water scarcity and urban population dynamics, there are few comprehensive reviews, especially focused on the particular situation in Sub-Saharan Africa. This paper contributes to interdisciplinary understanding of urban water supply by distilling and integrating relevant empirical knowledge on urban dynamics and water issues in SSA, focusing on progress made and associated challenges. It then points out future research directions including the need to understand how alternatives to centralized water policies may help deliver sustainable water supply to cities and informal settlements in the region.

Almost a billion people globally lack access to potable water. In the early 1990’s, attempts to improve potable water access in the global south included a massive push for water services privatization, often involving the transfer of public water services to private companies. Critics of water privatization claim it rarely improves access to water, and in most cases, unfairly affect poor people. Proponents on the other hand argue that it is necessary for efficient management and capital investment in the water sector. Although development NGOs play an important role in developing country water provision, hardly any studies have sought to understand their perceptions about the potential role of water privatization towards improving access to potable water in developing countries. We interviewed the key staff among 28 international and national NGO staff about water privatization, its opportunities and constraints. Their perceptions were mixed. While most criticized water privatization as increasing water costs to the poor, some noted that privatization is necessary for improving water access through increased capital investment. We present the findings and discuss larger implications for water policies and reforms in developing countries.

Recent land grabs in Sub-Saharan Africa are influenced by both land availability and access to water resources beyond seasonal rains. However, much of the literature has treated land grabs and their attendant water resource appropriations as separate phenomena until recently. This paper examines the complex interplay of land grabs and surface water appropriations in large-scale plantation agriculture in two agro-ecological zones in Ghana. Using mixed methods (actor interviews, focus groups, and smallholder farmer surveys), three case studies, and theoretical insights from political ecology and the hydrosocial cycle, it explores the local conditions, actor interests, motivations, and power relations; decision making; and institutional lapses that enable land grabs to go in tandem with water resource appropriations. The results show that although land and water grabs were intricately intertwined, investor negotiations for land rarely included water use rights. Motivated by the notion of abundant, unused water, investors carefully negotiated access to water for irrigation, including offering social benefits in exchange for unrestricted water use. Uneducated traditional leaders were mostly oblivious to national legislation and institutional arrangements for land and water use and sometimes unknowingly sanctioned unlimited water use by investors. Farmers were more concerned about land dispossessions and agrochemical threats to water quality, not water rights abuse. The findings expose often-overlooked forms of water appropriations driven by land grabs and highlight their hydrosocial ramifications in the drought-prone savanna belt of Ghana.

Solid waste production from excessive consumption remains one of the most pressing global environmental challenges currently. Particularly for burgeoning cities of developing countries, rapid population growth tend to exacerbate the problem, with profound public health and environmental consequences. In Ghana, over 4.5 million tons of municipal solid waste is produced annually. Public waste management services are barely able to keep pace with the rate of solid waste production. Recently, private waste-management services have emerged as one possible solution, therefore opening a set of research questions among which being what factors influence households to utilize such services. Through a multi-stage random sample of 660 households, we explored household utilization of private solid-waste management services, specifically focusing on what socio-behavioural factors may help explain levels utilization. Descriptive statistics show that 68% of the respondents did not utilize private waste management services. Logistic regression analyses revealed gender (OR = 0.116, p = 0.003), perception of waste as a problem (OR= 0.234, p = 0.027), awareness of existing waste management options (OR = 5.561, p = 0.008), knowledge about waste management service providers (OR = 0.013, p = 0.001) and cost of waste management services (OR = 0.839, p < 0.001) as significant predictors of household waste management services utilization. We conclude with a discussion of the broader policy implications of our results in the context of addressing the growing menace of excessive solid waste production in the global south.