Safe drinking water is critical to human health and development. In rural sub‐Saharan Africa, most improved water sources are boreholes with handpumps; studies suggest that up to one third of these handpumps are nonfunctional at any given time. This work presents findings from a secondary analysis of cross‐sectional data from 1509 water sources in 570 communities in the rural Greater Afram Plains (GAP) region of Ghana; one of the largest studies of its kind. 79.4% of enumerated water sources were functional when visited; in multivariable regressions, functionality depended on source age, management, tariff collection, the number of other sources in the community, and the district. A Bayesian network (BN) model developed using the same data set found strong dependencies of functionality on implementer, pump type, management, and the availability of tools, with synergistic effects from management determinants on functionality, increasing the likelihood of a source being functional from a baseline of 72% to more than 97% with optimal management and available tools. We suggest that functionality may be a dynamic equilibrium between regular breakdowns and repairs, with management a key determinant of repair rate. Management variables may interact synergistically in ways better captured by BN analysis than by logistic regressions. These qualitative findings may prove generalizable beyond the study area, and may offer new approaches to understanding and increasing handpump functionality and safe water access.

Participatory approaches are an important component of institutional frameworks for the governance of water resources and services. Studies on public participation in water management provide evidence for the outcomes of public participation and insights into the types of methods and the contexts under which participation can be meaningful. However, participatory processes are complex, and there is no single method by which to interpret, approach and implement them. This paper explores elements from the theory and practice of participation, applied to the management of water resources and water and sanitation services. Based on an in-depth literature review, we analyze the forms of participation in water and sanitation, their outcomes, as well as the contextual factors and procedural elements of participatory processes that affect their success. Contextual factors are those that are largely outside of the control of agencies or participants (e.g., demographics, history, and culture) or those that can only be influenced by management and institutional decisions in the mid- and long-term (e.g., the legal and institutional framework); while procedural elements are those over which agencies and participants have considerable control when designing and executing participatory efforts (e.g., representativeness and inclusivity, access to information, and opportunity to influence). We propose a framework that interrelates and integrates both contextual factors and procedural elements of participation. It, includes three additional aspects that are influenced by, and in turn influence, the context and the process: existing capacities for implementation of meaningful participatory processes, the resources that are allocated to them, and attitudes towards participatory processes. The framework helps conceptualize what we call the enabling environment for active, free, and meaningful participation in the delivery of water and sanitation services. By breaking down the complexities of participation, the framework supports practitioners and decision-makers to better design and implement participatory processes in water resources and water and sanitation services.