Previous research has shown that despite the low-income levels in developing countries, cost recovery is a prerequisite for sustainability of urban water services. The challenge for service improvement is continually growing, as it is projected that 88% of all the increase in global population will live in urban centres of low-income countries by the year 2015. Yet bill collection efficiency in some African urban water utilities is lower than 50%. In order to improve cost recovery levels, the new public managerialism paradigm suggests that water utility managers need to change their business philosophy from being supply-driven to engendering customer focus. This study used empirical data, obtained through a cross-sectional survey in eleven major towns of Uganda to establish customer perceptions that influence bill payment behaviour of water utility customers. Regression analysis of data obtained showed that service value and customer satisfaction contribute about 20% of the variation in customer loyalty, which in turn significantly influences bill payment behaviour. Therefore, in order to improve cost recovery, utility managers have to work towards improving customer satisfaction and perceived value of the services delivered. The effect of corporate image, of significance in high-income countries, was not found to be relevant in Uganda.

Keywords:urban water services, cost recovery, household characteristics Maximising cost recovery is currently a top priority for managers of urban water utilities in low-income countries. This research was carried out in 11 major towns of Uganda to establish which household characteristics influence payment for water services. A questionnaire was used to collect data on Customer Satisfaction, Customer Loyalty and several socio-economic variables. Using regression techniques, it was established that the following attributes of the household head moderated the satisfaction/loyalty relationship: gender, occupation and level of education. Other significant factors were household income, and property tenure status. These results could be used to make water utilities customer-focused.

Extreme weather events pose significant threats to urban health in low-and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of the cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas.Health facilities are sited in low-lying areas with poor drainage systems and can be 6°C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities.Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.

A global research programme was undertaken to investigate the actual costs and charges of obtaining a water connection in urban areas. Drawing from the Uganda case study, this paper will contribute to the understanding of the enormity of the barriers of the connection process and costs levelled against the urban poor, and the importance of programmes and pricing structures for enabling access to the water supply systems. The researchers found a mean cost of new water connection of US$500 (median of $197). This is unaffordable for $2 per-day-households, which are therefore unable to access the benefits from piped water services.

Providers of municipal water supply services worldwide are facing pressure from climate change and increasing water demand due to growing populations and lifestyle changes. With finite global freshwater supplies, there is need for water service providers to consider water demand management as an option for closing the supply-demand gap. Several water utilities in the UK are implementing residential water efficiency initiatives, but to-date, the effectiveness of these programmes have not been comprehensively evaluated. The present study uses statistical analysis to evaluate the effectiveness of a domestic water efficiency programme, initiated by a major water supply company in South East England. Using multilevel regression, water consumption, weather and demographic data, the study analysed water savings achieved through the efficiency programme and defined the factors that affect a household's potential to save water. Analysis showed that households that participated in the programme reduced their per capita consumption by approximately 15%. Importantly, research findings provide strong evidence that single resident and financially stretched households have a bigger potential to conserve water than wealthier and larger households do. This study also highlights the robustness of multilevel analysis, even in cases of data limitations. The findings generate implications for policy and practice, which are useful for water companies involved in implementing water efficiency programmes, as well as their evaluation.