Access to water, sanitation, and hygiene (WASH)—including drainage-services—is essential for public health and socio-economic development, but access remains inadequate and inequitable in low- to middle-income countries such as South Africa. In South Africa, rural areas and small towns generally depend on a limited and climate-sensitive economic base (e.g., farming), and they have a limited capacity and are located in areas where transport challenges can increase WASH access risks. Climate change shifts hydrological cycles, which can worsen WASH access and increase susceptibility to the interlinked impacts of droughts and flooding in already vulnerable regions. We adopted a transdisciplinary approach to explore the needs, barriers, and vulnerabilities with respect to WASH in rural areas and small towns in South Africa—using two case studies to explore climate risk and vulnerability assessment (CRVA) in one rural village in the northern Limpopo province and a small town in the Western Cape province. This holistic approach considered natural (environment and climate) and socio-economic (economic, social, governance, and political) factors and how they interplay in hampering access to WASH. Extreme weather events characterized by frequent and intense droughts or floods aggravate surface and groundwater availability and damage water infrastructure while threatening agriculture-dependent livelihoods. The lack of reliable transport infrastructure increases risks posed by flooding as roads to vital supplies are prone to damage. High inequality linked to rising unemployment and the Apartheid legacy of a segregated service delivery system result in inequitable access to WASH services. The intertwined ways in which natural elements and historical, social, economic, governance, and policy aspects are changing in South Africa increase WASH vulnerability in rural areas and small towns.

In the face of water related risks resulting from climate change and rapid urbanization, water resources in South African cities have increasingly come under pressure. Following the most recent drought period (2015–2018), local authorities such as the City of Cape Town are being tasked with restructuring policy to include climate change adaptation strategies to adapt more adequately and proactively to these new challenges. This paper describes an evaluation of the water governance processes required to implement Water Sensitive Urban Design (WSUD) in Cape Town—with a specific focus on the barriers to, and opportunities for, those processes related to wastewater treatment, flood risk and the pressing issue of water scarcity. The City Blueprint Approach (CBA) was selected as the indicator assessment approach for this task. The CBA is a set of diagnostic tools comprising the Trends and Pressures Framework, the City Blueprint Framework and the Governance Capacity Framework. This was applied to Cape Town based on in-depth interviews and publicly available information. The analysis revealed that smart monitoring, community knowledge and experimentation with alternative water management technologies are important when considering uncertainties and complexities in the governance of urban water challenges. We conclude that there is potential for Cape Town to transition to a water sensitive city through learning from this experimentation and by implementing WSUD strategies that address water scarcity following the shifts in governance caused by the 2015–2018 drought.

Background: There is limited data on the association between diarrhoea among children aged under five years (U5D) and water use, sanitation, hygiene, and socio-economics factors in low-income communities. The study investigated U5D and the associated risk factors in the Zeekoe catchment in Cape Town, South Africa. Methods: A cross-sectional study was conducted in 707 households in six informal settlements (IS) two formal settlements (FS) (March–June 2017). Results: Most IS households used public taps (74.4%) and shared toilets (93.0%), while FS households used piped water on premises (89.6%) and private toilets (98.3%). IS respondents had higher average hand-washing scores than those of FS (0.04 vs. −0.14, p = 0.02). The overall U5D prevalence was 15.3% (range: 8.6%–24.2%) and was higher in FS than in IS (21.2% vs. 13.4%, respectively, p = 0.01). Water storage >12 h was associated with increasing U5D (OR = 1.88, 95% CI 1.00–3.55, p = 0.05). Water treatment (OR = 0.57, 95%CI 0.34–0.97, p = 0.04), good hand-washing practices (OR = 0.59, 95%CI 0.42–0.82, p = 0.002) and Hepatitis A vaccination (OR = 0.51, 95%CI 0.28–0.9, p = 0.02) had significant preventing effects on U5D. Conclusions: The study highlights that good hygiene practice is a key intervention against U5D in informal settlements. The promotion of hand-washing, proper water storage, and hygienic breastfeeding is highly recommended.

The drought experienced in South Africa in 2016 – one of the worst in decades – has left many urbanised parts of the country with limited access to water, and food production has been affected. If a future water crisis is to be averted, the country needs to conserve current water supplies, reduce its reliance on conventional surface water schemes, and seek alternative sources of water supply. Within urban areas, municipalities must find ways to adapt to, and mitigate the threats from, water insecurity resulting from, inter alia, droughts, climate change and increasing water demand driven by population growth and rising standards of living. Stormwater harvesting (SWH) is one possible alternative water resource that could supplement traditional urban water supplies, as well as simultaneously offer a range of social and environmental benefits. We set out three position statements relating to how SWH can: improve water security and increase resilience to climate change in urban areas; prevent frequent flooding; and provide additional benefits to society. We also identify priority research areas for the future in order to target and support the appropriate uptake of SWH in South Africa, including testing the viability of SWH through the use of real-time control and managed aquifer recharge. Significance: Addresses water scarcity through building resilience to the impacts of climate change; improving the liveability of cities; and prioritising water-sensitive urban design.

The use and disposal of greywater in the non-sewered areas of South Africa: Part 1 – Quantifying the greywater generated and assessing its quality