About 20 Million (73%) people in Nepal still do not have access to safely managed drinking water service and 22 million (79%) do not treat their drinking water before consumption. Few studies have addressed the combination of socio-economic characteristics and psychosocial factors that explain such behaviour in a probabilistic manner. In this paper we present a novel approach to assess the usage of household water treatment (HWT), using data from 451 households in mid and far-western rural Nepal. We developed a Bayesian belief network model that integrates socio-economic characteristics and five psychosocial factors. The socio-economic characteristics of households included presence of young children, having been exposed to HWT promotion in the past, level of education, type of water source used, access to technology and wealth level. The five psychosocial factors capture households' perceptions of incidence and severity of water-borne infections, attitudes towards the impact of poor water quality on health, water treatment norms and the knowledge level for performing HWT. We found that the adoption of technology was influenced by the psychosocial factors norms, followed by the knowledge level for operating the technology. Education, wealth level, and being exposed to the promotion of HWT were the most influential socio-economic characteristics. Interestingly, households who were connected to a piped water scheme have a higher probability of HWT adoption compared to other types of water sources. The scenario analysis revealed that interventions that only target single socio-economic characteristics do not effectively boost the probability of HWT practice. However, interventions addressing several socio-economic characteristics increase the probability of HWT adoption among the target groups.

The sustainability of the water supply program in developing countries is influenced by many inter-linked and dynamic factors, suggesting the need to analyse the system behaviour of the water supply program. However, no study analyses factors influencing the sustainability of rural drinking water supply programs holistically, and this study aims to fill that gap. This study utilized a system dynamics approach based on a case study of a community-based rural drinking water supply program (PAMSIMAS in Bahasa) in Magelang Regency, Indonesia. Five sustainability aspects were considered in the model development and simulation: financial, institutional, environmental, technical, and social aspects. Eight scenario analyses related to those five aspects were conducted. The causal loop diagrams suggest that the overall loop in the system is reinforcing, meaning that the improvement in one aspect will improve the overall condition of the system and deterioration in one aspect will reduce the overall condition of the system. Scenario analysis shows that external fund is critical to support the program financially, especially at the beginning of the project when the piped system is being built and water revenue is still low. Scenario and sensitivity analyses revealed that human factors, i.e., the performance of the water board and response and support from the community, positively influence the sustainability of the water supply program. Additionally, the water board plays a key role in accelerating the pipe network growth. Finally, this paper argues that visualising and simulating the causal relationship and dynamic behaviour of the rural water supply program are critical for water stakeholders to better design and implement the water supply program.

Accurate assessments of drinking water quality, household hygenic practices, and the mindset of the consumers are critical for developing effective water intervention strategies. This paper presents a microbial quality assessment of 512 samples from household water storage containers and 167 samples from points of collection (POC) in remote rural communities in the hilly area of western Nepal. We found that 81% of the stored drinking water samples (mean log₁₀ of all samples = 1.16 colony-forming units (CFU)/100 mL, standard deviation (SD) = 0.84) and 68% of the POC samples (mean log₁₀ of all samples = 0.57 CFU/100 mL, SD = 0.86) had detectable E. coli. The quality of stored water was significantly correlated with the quality at the POC, with the majority (63%) of paired samples showing a deterioration in quality post-collection. Locally applied household water treatment (HWT) methods did not effectively improve microbial water quality. Among all household sanitary inspection questions, only the presence of livestock near the water storage container was significantly correlated with its microbial contamination. Households’ perceptions of their drinking water quality were mostly influenced by the water’s visual appearance, and these perceptions in general motivated their use of HWT. Improving water quality within the distribution network and promoting safer water handling practices are proposed to reduce the health risk due to consumption of contaminated water in this setting.

Household water treatment (HWT) can effectively reduce exposure to unsafe drinking water at home. Understanding the characteristics of target groups who successfully adopt HWT, such as perception about water quality and usefulness of HWT, income, or parental education, is essential for enhancing the adoption of HWT in developing countries. The objective of this study is to analyze the interactions between such socio-environmental characteristics, rather than a single characteristic, in order to explain the adoption of HWT. Five socio-environmental characteristics and behavior determinants were analyzed using Qualitative Comparative Analysis (QCA) from 41 case studies in Africa, Asia, and South America. Results show that there is no single characteristic that alone explains the adoption of HWT. QCA identified five pathways leading to high adoption of HWT. Perceived threat due to bad water quality is a pre-condition for three of the pathways. However, perceived threat does not alone explain adoption of HWT and must be accompanied by other conditions. Households connected to piped water schemes can also be potential HWT adopters as long as they perceive poor tap water quality. Finally, households who are able to afford the full cost of HWT tend to adopt it only when they neither have prior experience with HWT nor a connection to a piped scheme. Our findings therefore highlight the necessity to analyze interactions between socio-environmental characteristics of households and behavior determinants in order to determine the adoption of HWT.

Psychological frameworks are rarely used to understand irrigation adoption behaviour in developing countries. A Bayesian belief network (BBN) model was developed that integrated socio-economic characteristics and psychological factors to understand farmer behaviours with respect to irrigation practices in four districts of Maharashtra, India. Strong norms, risk perceptions of water scarcity, and attitude play roles in the adoption of irrigation technology and practices. Critically, it was found that no one factor can explain adoption behaviour; rather, an ensemble of factors is needed to understand farmer behaviour. A farmer who is highly educated, middle-aged, and moderately wealthy with a significant level of family help and an open well as their main water source, while receiving low promotional information related to water scarcity and irrigation adoption, is most likely to adopt irrigation technology. The application of the BBN in this study enables stakeholders and policymakers to better understand the linkages between different factors and behaviour.

Background: There is increasing recognition of the complexity underlying WASH conditions in developing countries. This article explores the complexity by assessing the vulnerability of a specific area to poor WASH conditions using a qualitative approach. Methods: We present our findings for the district of East Sumba in Indonesia. This area is known as one of the poorest regions in Indonesia with inadequate WASH services, indigenous belief that hinder the practice of WASH-related behaviours, and has a high rate of children malnutrition. All the factors that contribute to poor WASH conditions were discussed through the lens of the Financial, Institutional, Environmental, Technological, and Social (FIETS) framework. We then summarised the factors and visualized the “system” using a mind map which shows how factors are interconnected and helps to find the root causes of poor WASH conditions. Results: There are three main challenges that inhibit the improvement of WASH conditions in this area: inadequate institutional capacity, water scarcity, and poor socio-economic conditions. We found that a village leader is the most important actor who influences the sustainability of WASH services in this area and healthcare workers are influential WASH promoters. This study also shows how culture shapes people’s daily lives and institution performance, and influences the current WASH conditions in East Sumba. The mind map shows there is an overlap and interconnection between FIEST aspects and WASH conditions in the study area. Conclusion: WASH conditions are influenced by many factors and are often interconnected with each other. Understanding this complexity is necessary to improve WASH conditions and sustain adequate WASH services in developing countries. Finally, WASH interventions have to be considerate of the prevailing cultural practices and should involve multidisciplinary stakeholders.