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Low-cost domestic rainwater harvesting in rural southeast Madagascar: A process and outcome evaluation [1]

['Jasmine Kelly', 'Department Of Water', 'Sanitation', 'Hygiene', 'Seed Madagascar', 'Fort Dauphin', 'Anosy', 'Mamonjisoa Tsilahatsy', 'Tolotra Carnot', 'Ramanantsiadiana Wilmin Fidelos']

Date: 2023-11

Abstract In settings where communities rely on unimproved water sources, household rainwater harvesting (HRWH) may improve the quality and quantity of water available. This research presents results from a two-year controlled before-and-after study that evaluated the impact of low-cost HRWH on household water collection habits, hygiene practices and prevalence of childhood diarrhoea in rural Madagascar. The study assessed system functionality, water quality and the acceptability of requesting household financial investment (16–20 USD). Surveys were administered to enrolled intervention households (n = 138) and control households (n = 276) at baseline and endline. Water quality tests at endline compared microbial contamination in a sub-sample of HRWH systems (n = 22) and public water sources (n = 8). Difference-in-difference analyses were used to compare changes in outcomes between study arms at baseline and endline. At endline 111 (75%) of systems were functional with an average age of 1.25 years. Microbial contamination was 39.3 TTC/100ml in community water sources compared with 23.3 TTC/100ml in the HRWH systems (coef: -16.0, 95CI: -37.3 to 5.2, p = 0.133). 85 (57%) of households completed their repayment plans while remaining households owed on average 3.7 USD. There was weak evidence to suggest that intervention households collected more water per capita day than controls (adj coefficient: 3.45; 95CI: -2.51 to 9.41, p = 0.257). Intervention households had 11% higher absolute risk of owning a handwashing station compared against controls (95CI: 0.00 to 0.23; p = 0.06). There was no evidence of differences in ownership of soap or prevalence of childhood diarrhoea between study arms. Overall, operation and maintenance of the systems remained high, users demonstrated willingness to pay, and there was weak evidence that water provision at the household increased domestic consumption. However, the systems did not provide contaminant-free water. We conclude that HRWH using low-cost, locally available materials can increase household access to water in areas reliant on limited communal water sources.

Citation: Kelly J, Tsilahatsy M, Carnot T, Fidelos RW, Randriamanampy G, Charlier AZ, et al. (2023) Low-cost domestic rainwater harvesting in rural southeast Madagascar: A process and outcome evaluation. PLOS Water 2(10): e0000053. https://doi.org/10.1371/journal.pwat.0000053 Editor: Sara Marks, Eawag, SWITZERLAND Received: August 2, 2022; Accepted: September 1, 2023; Published: October 25, 2023 Copyright: © 2023 Kelly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Data generated by this research has been de-identified and provided under supplementary materials of the manuscript. Funding: This study was funded by The Travers Cox Charitable Foundation as part of the project "Tatirano" under NGO SEED Madagascar (HC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist.

Introduction Access to a safely managed water supply is a key part of Sustainable Development Goal (SDG) 6 and is associated with increased household consumption of water, improved hygiene practices and lower incidence of diarrhoeal disease [1–3]. While progress towards SDG6 continues to improve globally, this progress is not equitable and of the 86 countries currently with less than 95% access to a basic water supply, 71 are not on target to reach universal coverage by 2030 [4]. An important factor limiting access to safe water is the poor sustained functionality of water supply interventions [5, 6]. Interventions that require financial contributions from users have been shown to increase water source lifespan [7]. However, in some rural settings, these approaches are not always enough to make a community water supply sustainable [8]. In these instances, interventions at the household level that offer a supported self-supply, such as household rainwater harvesting (HRWH), offer a promising but under-researched alternative to community water sources, such as a public tap-stand or well [9, 10]. Household water supplies have the additional benefit of reducing the amount of time a household spends collecting water as well as increasing the amount of water consumed by the household, which in turn is associated with improved hygiene practices by household members [11, 12]. Rainwater harvesting (RWH) is a broad term used to describe the collection, storage and use of rainwater. It has been utilised in a variety of climates and socioeconomic settings as a solution to water scarcity, intermittence of water supply, and inadequate drinking water quality [13–15]. The joint monitoring programme currently lists RWH as an improved water source and previous studies of HRWH interventions have indicated that the technology can yield potable water with low levels of microbial contamination [8]. However, water quality and yield are highly dependent on design specification and previous studies have shown that rainwater should not be consumed without treatment [8]. While widespread as a practice in some countries, HRWH has achieved only limited coverage in many settings within Sub-Saharan Africa and Asia where there are suitable climates as well as the requisite need for reducing reliance on surface water as a primary drinking water source. This under-utilisation of HRWH is in part due to the reliance on technology, materials and expertise that are not accessible in many rural, low-income settings [1, 2, 6]. This paper presents results from a process and outcome evaluation for a partially subsidized, domestic rainwater harvesting intervention delivered in rural southeast Madagascar over a 28-month period. The outcome evaluation assesses the impact of the intervention on water collection habits, including per capita household consumption and time spent collecting water, access to hygiene facilities, and prevalence of diarrhoea in children under five years of age. The process evaluation examined intervention acceptability, adherence to household payment schedules, HRWH system functionality, and the water quality parameters of water stored in the HRWH systems. The findings can help to inform national water, sanitation, and hygiene (WaSH) programmes designing alternative water supply financing and delivery mechanisms that seek to address sustainability of WaSH in Madagascar and other countries with similar profiles in Sub-Saharan Africa and beyond.

Discussion Results from this study demonstrate that a partially subsidised, low-cost HRWH system, built using locally available materials can offer an acceptable household-level water source in a low-income, water abundant environment. In this study, the majority of households continued to operate their systems until endline and among those that continued to use the system, operation and maintenance of the systems remained high at endline. Users also demonstrated a willingness to pay for the systems despite the high relative cost. However, despite the high levels of adherence to operation and maintenance, the systems were not capable of providing water free from microbial contamination. Additionally, limited storage capacity inhibited the ability of households to rely exclusively on the systems for their domestic water requirements, in turn resulting in only minor gains in household water consumption and no observed reduction in the time spent collecting water by household members. Household adherence to and satisfaction with payment schedules was high, with most households completing their payment plans and the remainder repaying on average 79% of their payment plans. This finding suggests that households were willing to allocate significant financial resources towards a household water supply, despite having access to existing community water sources in close proximity. Previous studies evaluating cost-recovery models for community water supplies in Kenya, Uganda, and Rwanda demonstrated similar findings [25], with users’ content to allocate financial resources to water supply if the convenience and quality of the water supplied is perceived to be high. However, despite target communities being located in a region where the World Bank estimates 96% of households live below 2 USD/day [18], households enrolled in the intervention arm of this study tended to be drawn from the higher socioeconomic strata within study communities. This indicates that less wealthy households may have been prevented from enrolling due to financial barriers, a finding that has been replicated by studies in Ghana and India [26, 27]. However, as indicated in Table 5, some control households did adopt the RWH systems as their primary source of drinking water by endline (2 control households, 1.5%). While it is outside the scope of this research, the possibility of exploring communal or shared RWH systems in this context could address the inherent inequality of affordability. Durability and functionality of the HRWH systems over the two-year study period was high, despite low observed water levels at endline. Metal roofed systems functioned better over time than palm leaf systems, with 85% of metal systems functional at endline versus 65% of palm leaf systems, despite metal systems having a higher mean age at endline. This difference is likely due to the varied durability of the materials used in these roof types and indicates that, in this setting, the palm leaf systems demonstrated only a limited long-term functionality. In line with functionality, palm leaf systems also performed worse than metal systems in terms of water quality and had similar Levels of microbial contamination compared with existing community water sources. Metal systems showed markedly lower levels of contamination, but were not free from faecal contaminants, indicating that in this setting—even with high levels of adherence to operation and maintenance—low-cost HRWH systems do not provide water that is safe to drink at point of access. This is in line with findings from previous studies suggesting that domestic rainwater harvesting structures often require additional treatment after collection to meet health and safety standards [8, 28–30]. A recent pooled cohort study from Bangladesh also indicates that rainwater has lower levels of minerals compared with groundwater, and as such exclusive use can have negative cardiometabolic health outcomes [31]. Impact outcomes Results from this study did not provide strong evidence to support the widely reported phenomenon that provision of a water source at the household increases domestic water consumption [2, 32]. However, in this setting, only a quarter of functional systems were observed as having water in the tank at endline and few households in receipt of the intervention reported relying on the HRWH as their primary drinking water source. In addition to this, user satisfaction was at its lowest when considering the quantity of water delivered by the system, with almost half of intervention households reporting dissatisfaction. This suggests that the yield of the 250L HRWH system was insufficient to meet households’ domestic water requirements and may have contributed towards the lack of observed impact on prevalence of self-reported childhood diarrhoea among recipient households. For future HRWH interventions, steps should be taken to ensure that systems can meet the water demand of households. We attribute the lack of water in most systems to the season in which the endline data was collected. Average monthly climatology of Madagascar indicates that October is the last of a six-month dry season [33]. This suggests that water reserves would have been lowest at this time of year. The borderline significant increase in observed number of handwashing stations within 10 meters of the household supports findings from previous studies that provision of a household water source can result in improved hygiene behaviours [11, 34, 35]. Study limitations As with most research conducted in resource limited settings, this study had several limitations. First, due to ethical considerations, participant households were not randomised prior to intervention delivery, and as such findings comparing results between control and intervention households are vulnerable to confounding. Propensity score matching, controlling for socio-economic difference in multivariate models, and use of a difference-in-difference analysis approach was used to account for potential selection bias, but residual confounding may have persisted. Intervention households were, by definition, those that decided the cost of the HRWH system was affordable, as such our measure of satisfaction with the cost of the system could be biased due to self-selection. Additionally, limited resources prohibited more regular data collection on water consumption and water quality and as a result the high levels of seasonal variation in rainfall were not captured in the data. Endline surveys were collected during the dry season which may have caused an underestimation of water consumption and contributed to the low number of systems with observed water. Due to funding constraints, only a limited number of HRWH systems could be sampled to assess microbial water quality parameters, which negatively impacted the precision of these estimates and our ability to detect differences between HRWH systems and community water sources. Additionally, we acknowledge the limitations of TTC as an indicator of faecal contamination.

Conclusion Findings from this study contribute towards the growing evidence base that supported self-supply intervention models offer a promising alternative to supply-driven interventions, even in extremely low-resource settings. Specifically, in this study we have demonstrated that demand exists for water supply infrastructure despite estimates that most of the population live on less than 2 USD/day and have abundant access to existing unimproved community water sources. Further to this we have shown that low-cost water supply infrastructure, manufactured using locally available materials can maintain functionality over an extended time-period. However, as programmes continue to weigh the relative benefits of decentralised, lower-cost water supply models, it is important to ensure that point of use water quality is protected and where this is not possible, provision for affordable and sustainable water treatment options are made available. It is also important to note that capacity of systems and seasonal rainfall should be considered in order to provide a consistent, year-round supply using HRWH systems in this setting.

Acknowledgments We would like to acknowledge the support and contributions of SEED Madagascar, both at the headquarters and Fort Dauphin offices, Tatirano Social Enterprise, the Madagascar Ministry of Health and Medical Inspector of the Fort Dauphin District Health Service, and the communities and participants of Mahatalaky Rural Commune.

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[1] Url: https://journals.plos.org/water/article?id=10.1371/journal.pwat.0000053

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