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Background The COVID-19 pandemic has highlighted important needs in water, sanitation and hygiene (WASH) services and standard practices for infection prevention and control in sub-Saharan Africa. We assessed the availability of WASH and standard precautions for infection prevention in health facilities across 18 countries in sub-Saharan Africa, as well as inequalities by location (rural/urban) and managing authority (public/private). Data from health facility surveys conducted between 2013 and 2018 in 18 sub-Saharan African countries were used to estimate the access to an improved water source within 500 m, an improved toilet, soap and running water or alcohol-based hand rub, and standard precautions for infection prevention at health facilities. Rural-urban differences and public-private differences in access to services were calculated. We also compared population level access to health facility access to services. Result Overall, 16,456 health facilities from 18 countries were included. Across countries, an estimated 88 % had an improved water source, 94 % had an improved toilet, 74 % had soap and running water or alcohol-based hand rub, and 17 % had standard precautions for infection prevention available. There was wide variability in access to water, sanitation and hygiene services between rural and urban health facilities and between public and private facilities, with consistently lower access in both rural and public facilities. In both rural and urban areas, access to water, sanitation and hygiene services was ubiquitously better at health facilities than households. Conclusions Availability of WASH services in health facilities in sub-Saharan Africa has improved but remains below the global target of 80 % in many countries. Ensuring adequate access to WASH services and enforcing adherence to safety and hygiene practices in health facilities will be essential to minimize the risk of COVID-19 transmission.
Mufaro Kanyangarara; Savannah Allen; Safia S Jiwani; David Fuente. Access to water, sanitation and hygiene services in health facilities in sub-Saharan Africa 2013–2018: Results of health facility surveys and implications for COVID-19 transmission. BMC Health Services Research 2021, 21, 1 -11.
AMA StyleMufaro Kanyangarara, Savannah Allen, Safia S Jiwani, David Fuente. Access to water, sanitation and hygiene services in health facilities in sub-Saharan Africa 2013–2018: Results of health facility surveys and implications for COVID-19 transmission. BMC Health Services Research. 2021; 21 (1):1-11.
Chicago/Turabian StyleMufaro Kanyangarara; Savannah Allen; Safia S Jiwani; David Fuente. 2021. "Access to water, sanitation and hygiene services in health facilities in sub-Saharan Africa 2013–2018: Results of health facility surveys and implications for COVID-19 transmission." BMC Health Services Research 21, no. 1: 1-11.
This paper presents country-level estimates of water, sanitation and hygiene (WASH)-related mortality and the economic losses associated with poor access to water and sanitation infrastructure in sub-Saharan Africa (SSA) from 1990 to 2050. We examine the extent to which the changes that accompany economic growth will “solve” water and sanitation problems in SSA and, if so, how long it will take. Our simulations suggest that WASH-related mortality will continue to differ markedly across countries in sub-Saharan Africa. In many countries, expected economic growth alone will not be sufficient to eliminate WASH-related mortality or eliminate the economic losses associated with poor access to water and sanitation infrastructure by 2050. In other countries, WASH-related mortality will sharply decline, although the economic losses associated with the time spent collecting water are forecast to persist. Overall, our findings suggest that in a subset of countries in sub-Saharan Africa (e.g., Angola, Niger, Sierra Leone, Chad and several others), WASH-related investments will remain a priority for decades and require a long-term, sustained effort from both the international community and national governments.
David Fuente; Maura Allaire; Marc Jeuland; Dale Whittington. Forecasts of mortality and economic losses from poor water and sanitation in sub-Saharan Africa. PLoS ONE 2020, 15, e0227611 .
AMA StyleDavid Fuente, Maura Allaire, Marc Jeuland, Dale Whittington. Forecasts of mortality and economic losses from poor water and sanitation in sub-Saharan Africa. PLoS ONE. 2020; 15 (3):e0227611.
Chicago/Turabian StyleDavid Fuente; Maura Allaire; Marc Jeuland; Dale Whittington. 2020. "Forecasts of mortality and economic losses from poor water and sanitation in sub-Saharan Africa." PLoS ONE 15, no. 3: e0227611.
Across the globe, many low- and middle-income countries are investing in their first generation of piped water and sanitation infrastructure. At the same time, the water and sanitation infrastructure in many industrialized countries is reaching, or has reached, the end of its useful life. Governments will need to mobilize substantial resources to finance this global water and sanitation infrastructure transition and user charges (tariffs) will play an integral role in supporting these efforts. This paper presents the results of a systematic review of the empirical literature on the design and evaluation of tariffs for municipal water and sanitation services, highlighting ways in which insights from the literature might inform policy and identifying areas for future research. Overall, we find that the empirical literature on pricing municipal water and sanitation services is diverse. Studies identified through our systematic review are published in a wide range of journals and vary considerably with respect to their primary aims, methods, number of tariffs analyzed, and the metrics used to evaluate different tariffs. The majority of studies examine two or fewer metrics of tariff performance, limiting the extent to which the literature characterizes the tradeoffs policy makers face when setting tariffs for municipal water and sanitation services. Finally, the majority of studies in the literature focus on water pricing in industrialized countries, highlighting an opportunity for research on water pricing in low- and middle-income countries.
David Fuente. The design and evaluation of water tariffs: A systematic review. Utilities Policy 2019, 61, 100975 .
AMA StyleDavid Fuente. The design and evaluation of water tariffs: A systematic review. Utilities Policy. 2019; 61 ():100975.
Chicago/Turabian StyleDavid Fuente. 2019. "The design and evaluation of water tariffs: A systematic review." Utilities Policy 61, no. : 100975.
Aims: The Sustainable Development Goal (SDG) for water and sanitation seeks to achieve universal and equitable access to safe and affordable drinking water and access to adequate and equitable sanitation and hygiene. This article examines what governments are doing to achieve this, paying particular attention to actions that governments report taking to better serve the poor and other vulnerable populations (i.e. pro-poor governance). This article also assesses the extent to which, and how, UN-Water’s Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) has tracked governments’ efforts to reach the poor since the inception of this global monitoring effort. Method: This article employs qualitative document analysis and iterative coding to identify pro-poor governance themes examined in GLAAS reports from 2008 to 2016 and provides a quantitative summary of findings related to pro-poor governance from the most recent GLAAS surveys. Results: The dimensions of pro-poor governance and number of questions related to pro-poor governance in GLAAS surveys have increased from 2008 to 2016. While the majority of countries report taking actions to promote equity, many countries did not provide information about specific actions they were taking to provide better services to the poor. Moreover, several actions countries reported taking (e.g. implementing an increasing block tariff) are likely to be ineffective. Conclusion: The findings of this study raise concerns about the extent to which governments are taking – or are positioned to take – effective action to meet the SDG aspiration of safe and affordable water and sanitation services for all. Without information on what countries are doing to promote equity, policy makers and researchers are unable to discern which policies are effective in different contexts.
D Fuente; J Bartram. Pro-poor governance in water and sanitation service delivery: evidence from Global Analysis and Assessment of Sanitation and Drinking Water surveys. Perspectives in Public Health 2018, 138, 261 -269.
AMA StyleD Fuente, J Bartram. Pro-poor governance in water and sanitation service delivery: evidence from Global Analysis and Assessment of Sanitation and Drinking Water surveys. Perspectives in Public Health. 2018; 138 (5):261-269.
Chicago/Turabian StyleD Fuente; J Bartram. 2018. "Pro-poor governance in water and sanitation service delivery: evidence from Global Analysis and Assessment of Sanitation and Drinking Water surveys." Perspectives in Public Health 138, no. 5: 261-269.
The ability of water and wastewater utilities to provide high quality water and sanitation services for their customers now and in the future will be determined, in part, by utilities’ resilience to climate change. The extent to which utilities invest in the infrastructure, planning, and operational practices that increase resilience is affected by the extent to which water sector professionals perceive climate change and its related impacts as an important risk to utility operations. This study examines the perceptions of water sector professionals in Sub-Saharan Africa towards a variety of risks facing water and wastewater utilities. In particular, we surveyed participants at the 2016 African Water Association’s Congress in Nairobi, Kenya to assess their perceptions of several climate-specific and general risk factors that may disrupt utility service. We find that water sector professionals’ average risk perception toward impacts from eight different climate-specific factors on utilities is lower than their perceived risk associated with general risk factors. We also find that professionals in the sector that do not work directly for utilities are more concerned about climate-specific risks and climate change in general than utility professionals. These findings highlight the multiple, competing risks utilities face and the need for adaptation strategies that simultaneously address climate and non-climate concerns of utilities.
Katherine Connolly; Mbutu Mwaura; Jamie Bartram; David Fuente. Perceptions of climate-related risk among water sector professionals in Africa—Insights from the 2016 African Water Association Congress. International Journal of Hygiene and Environmental Health 2018, 221, 838 -846.
AMA StyleKatherine Connolly, Mbutu Mwaura, Jamie Bartram, David Fuente. Perceptions of climate-related risk among water sector professionals in Africa—Insights from the 2016 African Water Association Congress. International Journal of Hygiene and Environmental Health. 2018; 221 (5):838-846.
Chicago/Turabian StyleKatherine Connolly; Mbutu Mwaura; Jamie Bartram; David Fuente. 2018. "Perceptions of climate-related risk among water sector professionals in Africa—Insights from the 2016 African Water Association Congress." International Journal of Hygiene and Environmental Health 221, no. 5: 838-846.