Delivering Drinking Water by Truck in Humanitarian Contexts: Results from Mixed-Methods Evaluations in the Democratic Republic of the Congo and Bangladesh

Abstract

Water trucking is a commonly implemented, but severely under-researched, drinking water supply intervention in humanitarian response. To fill this research gap, we conducted three mixed-methods water trucking program evaluations in the Democratic Republic of the Congo and Bangladesh, including interviews, water point observations, household surveys, focus groups, and water quality testing. Results indicated that the programs had complex implementation structures involving multiple agencies and limited infrastructure to properly collect, treat, and deliver water. All programs met queueing time and distance indicators, did not meet water quantity indicators, and inconsistently met water quality indicators. Free chlorine residual (FCR) declined through the water chain, and household water Escherichia coli concentrations were associated with household FCR, receiving behavior change messages, storage container type, and distance from the distribution point. Users appreciated water trucking, especially compared to previous water sources, and expressed desires for increased quantity, improved quality, and consistent delivery. If water trucking programs are implemented, it is recommended to have the financial resources to install sanitary collection and distribution infrastructure, establish a management team of all implementation partners, ensure sufficient water quantity is delivered, ensure recommended FCR levels at distribution points, monitor FCR throughout distribution, and complete behavior change communication activities about the program and safe water storage with users.

Field Trial of an Automated Batch Chlorinator System at Two Shared Shallow Tubewells among Camps for Forcibly Displaced Myanmar Nationals (FDMN) in Cox’s Bazar, Bangladesh

“…The study found that less than 13% of household post-treated stored water provided piped water chlorination, and 3% of provided Aquatabs met the WHO-recommended free residual chlorine level [ 14 ]. Sikder et al, 2020, found that among FDMN camp households’ stored water, 71% of the bucket, 36% of in-line, and 60% of piped chlorinated water met the WHO-recommended free residual chlorine level [ 32 ]. However, our current Zimba chlorination study demonstrated that about 94% of post-treated water samples from the project-provided safe storage containers were within or above the WHO-recommended free residual chlorine level.…”

“…Strong chlorine smell and the taste was the predominant barrier to using chlorine products in the FDMN camps thus limiting the possibility of increasing chlorine concentration [ 14 , 32 ]. Our qualitative study found that respondents from most households (7 out of 10) detected a strong chlorine smell at the initial stage of Zimba installation, but they reported becoming habituated with the smell after four weeks of intervention.…”

Lessons learned from conducting six multi-country mixed-methods effectiveness research studies on water, sanitation, and hygiene (WASH) interventions in humanitarian response

“…In all six multi-country, mixed-methods evaluations, policy-relevant outcomes were obtained. We found: interventions could reduce the risk of disease in humanitarian contexts; this reduction of risk did not always occur, as there were large ranges of effectiveness; and, implementation factors were crucial to intervention effectiveness [11][12][13][14][15] (manuscripts in preparation). Please note that, to generate this manuscript of lessons learned from the process of conducting multi-country, mixedmethods evaluations, the lead investigators and researchers of the six studies met, discussed, and wrote up these lessons learned collaboratively.…”

“…To date, we have completed six multi-country, mixed-methods effectiveness studies in humanitarian response (Table 1), on: 1) distributions of household water treatment (HWT) [11]; 2) installation of source-based chlorination water treatment (Dispensers) [12]; 3) development of Water Safety Plans (WSPs) [13]; 4) spraying household surfaces with chlorine to prevent ongoing transmission of cholera (household spraying) [14]; 5) trucking water to an affected population (water trucking) [15]; and, 6) stationing a worker dispensing chlorine into water collection containers at water sources (bucket chlorination) (manuscript in preparation).…”

A Structural Equation Model to Decipher Relationships among Water, Sanitation, and Health in Colonias-Type Unincorporated Communities

“…A handful of researchers have utilized SEM to identify factors that impact perceived water quality, − while others have relied on summary statistics to analyze perception of sanitation and water quality in underserved communities. ,, The impacts of environmental health and household demographics on diarrheal health burden were explored with SEM in rural Guatemala and Brazil. , Specifically, this technique quantified the impact of higher education level, proper water filter maintenance, and improved water supply on reducing diarrheal health burden . Another study used a comparative SEM technique (i.e., grouping different sample populations) to reveal that environmental exposure variables related to diarrhea and systemic inflammation proxies varied between female and male children under five .…”