WaSH CQI: Applying continuous quality improvement methods to water service delivery in four districts of rural northern Ghana

Abstract

Continuous, safely managed water is critical to health and development, but rural service delivery faces complex challenges in low- and middle-income countries (LMICs). We report the first application of continuous quality improvement (CQI) methods to improve the microbial quality of household water for consumption (HWC) and the functionality of water sources in four rural districts of northern Ghana. We further report on the impacts of interventions developed through these methods. A local CQI team was formed and trained in CQI methods. Baseline data were collected and analyzed to identify determinants of service delivery problems and microbial safety. The CQI team randomized communities, developed an improvement package, iteratively piloted it in intervention communities, and used uptake survey data to refine the package. The final improvement package comprised safe water storage containers, refresher training for community WaSH committees and replacement of missing maintenance tools. This package significantly reduced contamination of HWC (p<0.01), and significant reduction in contamination persisted two years after implementation. Repair times in both intervention and control arms decreased relative to baseline (p<0.05), but differences between intervention and control arms were not significant at endline. Further work is needed to build on the gains in household water quality observed in this work, sustain and scale these improvements, and explore applications of CQI to other aspects of water supply and sanitation.

Identifying predictors of E. coli in rural household water in sub-Saharan Africa using elimination regression

“…Trials of safe storage interventions in West Africa have struggled to achieve high, sustained uptake, and improper storage was commonly observed (e.g., using a communal cup to scoop water instead of dispensing it via the tap). 48,49 The potential for water contamination after collection varies between settings. Contamination potential is exceptionally high in locations where water is collected offpremises, transported, and stored, as each step offers a new potential entry point for contamination.…”

Adaptation of Water, Sanitation, and Hygiene Interventions: A Model and Scoping Review of Key Concepts and Tools

“…Our systematic literature search yielded no examples that referenced core functions, nor analogous concepts under a different name. We found two examples of WaSH adaptation taking a systematic approach to assessing potential outcomes, but this was done through empirical data collection on key pre-selected outcomes using continuous quality improvement framework (21,86). Overall, the scope of potential outcomes considered by all WaSH studies was limited, typically only direct health impacts expected of the intervention (e.g., diarrheal disease prevalence) or intermediate outcomes such as functionality and use of WaSH infrastructure.…”

Demystifying the challenges of water, sanitation and hygiene in rural high schools

“…In some schools, learners clean their own toilets, with no personal protective equipment (PPE) such as mouth and nose masks and gloves provided. The targets set by the six Sustainable Development Goals (SDGs) on drinking water and sanitation called for the Department of Basic Education to improve levels of service (Fisher, Danquah, Seidu, Fechter, Saga and Bartram, 2020). A reliable supply of drinking water as well as safe management at the source and household level is included in these targets.…”