Sanitation programming success depends on users being satisfied with the proposed sanitation system and bathroom design. Past studies have described some households being dissatisfied with their current bathrooms and unwilling to accept a new bathroom because it is not modern; however, few studies have investigated how households define modern. To best support households in adopting improved sanitation infrastructure, or infrastructure that hygienically separates human waste from human contact, there is a need to understand characteristics associated with modern bathrooms and if modern encompasses more than the sanitation infrastructure. This study systematically identified characteristics associated with modern bathrooms across multiple sanitation infrastructure types. 305 households near Cascas, Peru, an area with diverse bathroom designs that have unimproved and improved sanitation infrastructure access, were surveyed to capture perceptions of modern. Results demonstrate that households often perceive a modern bathroom as one with a sitting-style toilet, a sink, and a shower. Most households did not associate sanitation infrastructure type with their definition of modern; however, all modern bathrooms had improved sanitation infrastructure. Future work should expand and test this definition of modern in other contexts to support future adoption of improved sanitation.

Ventura, R., Javernick-Will, A., and N. Gonzales. (2023). “Characterizing modern bathrooms to support sanitation adoption”. Journal of Water, Sanitation & Hygiene for Development. .

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We present a study design and baseline results to establish the impact of interventions on peri-urban water access, security and quality in Kasai Oriental province of the Democratic Republic of the Congo. In standard development practice, program performance is tracked via monitoring and evaluation frameworks of varying sophistication and rigor. Monitoring and evaluation, while usually occurring nearly concurrently with program delivery, may or may not measure parameters that can identify performance with respect to the project’s overall goals. Impact evaluations, often using tightly controlled trial designs and conducted over years, challenge iterative program evolution. This study will pilot an implementation science impact evaluation approach in the areas immediately surrounding 14 water service providers, at each surveying 100 randomly-selected households and conducting water quality assessments at 25 randomly-selected households and five water points every three months. We present preliminary point-of-collection and point-of-use baseline data. This study is utilizing a variety of short- and medium-term monitoring and impact evaluation methods to provide feedback at multiple points during the intervention. Rapid feedback monitoring will assess the continuity of water services, point-of-consumption and point-of-collection microbial water quality, household water security, household measures of health status, ability and willingness to pay for water and sanitation service provision, and service performance monitoring. Long-term evaluation will focus on the use of qualitative comparative analysis whereby we will investigate the combination of factors that lead to improved water access, security and quality.

Kirsch, K.*, Nagel, C., Iribagiza, C., Ecklu, J., Akonkwa Zawadi, G., Mugaruka Ntabaza, P., Barstow, C., Lund, A., Harper, J., Carlton, E., Javernick-Will, A., Linden, K., and E. Thomas, (2023).  “Study design and baseline to evaluate water service provision among peri-urban communities in Kasai Oriental, Democratic Republic of the Congo”. PLOS One. .

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Reliable water service delivery continues to be a complex global issue that is particularly challenging in rural communities. Despite billions of dollars of infrastructure interventions, sustainable water services remain out of reach for millions of people. Professionalized maintenance services have emerged as a service provision strategy to supplement the community-based rural water management approach. This study applies system dynamics modeling to assess the potential impact of scaling up professionalized maintenance services on piped water systems in Kitui County, Kenya. The study results show that over a 10 year simulation, calibrated with 21 months of empirical data and based on a range of key assumptions, delivery of professionalized maintenance services across the county may increase countywide functionality rates from 54% to over 83%, leading to a 67% increase in water production. Furthermore, the increase in preventive maintenance activities and proactive repairs can lead to less frequent major breakdowns and reduction in county government spending on major repairs by over 60%. However, current service fee income from communities accounts for 8% of the total cost of service, necessitating substantial sustained external financing or government subsidies to be financially viable at scale.

Chintalapati, P., Nyaga, C., Walters, J., Koehler, J., Javernick-Will, A.; Hope, R.; Linden, K. (2022). “Improving the reliability of water service delivery in rural Kenya through professionalized maintenance: a system dynamics perspective”. Environmental Science and Technology.  

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Collaborative approaches can overcome fragmentation by fostering consensus and connecting stakeholders who prioritize similar activities. This makes them a promising approach for complex, systemic problems such as lack of reliable, safe water, sanitation, and hygiene (WASH) services in low-income countries. Despite the touted ability of collaborative approaches to align priorities, there remains no comprehensive way to measure and map alignment within a network of actors. Methodological limitations have led to inconsistent guidance on if, and how much, alignment is needed around a common vision (e.g., universal, reliable access to WASH) and/or around an agreed set of activities (e.g. passing a bill to promote water scheme maintenance models). In this work, we first define alignment as the extent to which actors work with others who share priorities. We then develop and test a method that uses social network analysis and qualitative interview data to quantify and visualize alignment within a network. By investigating how alignment of two strong, well-functioning WASH collaborative approaches evolved over three years, we showed that while alignment on a common vision may be a defining aspect of collaborative approaches, some alignment around specific activities is also required. Collaborative approaches that had sub-groups of members that all prioritized the same activities and worked together were able to make significant progress on those activities, such as drafting and passing a county-wide water bill or constructing a controversial fecal sludge disposal site. Despite strong sub-group formation, networks still had an overall tendency for actors to work with actors with different prioritized activities. While this reinforces some existing knowledge about collaborative work, it also clarifies inconsistencies in theory on collaborative approaches, calls into question key aspects of network literature, and expands methodological capabilities.

 Pugel, K., Javernick-Will, A., Nyaga, C., Dimtse, D., Mussa, M., Henry, L., and K. Linden. (2022). “Mapping (mis)alignment within a collaborative network using homophily metrics”.  PLOS Water.  

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Professionalized maintenance arrangements are emerging and growing to improve rural
water service sustainability across sub-Saharan Africa, where local governments often act
as rural service authorities. Uganda’s Ministry of Water and Environment released a novel
policy in 2019 to promote professionalization, outlining requirements of local governments
to support professionalized maintenance under a new framework for rural water service
delivery. We identify how responsibilities of local government actors shifted under this policy
and then use Organizational Institutional Theory to explore how the institutional environment—
composed of regulative, normative, and cultural-cognitive pillars—influences these
actors’ fulfillment of assigned functions under the new policy and support of professionalized
maintenance arrangements. To do this, we collected, transcribed, and qualitatively coded
data from semi-structured interviews with 93 Ugandan local government actors at all hierarchical
levels across 22 sub-counties in three Ugandan districts. Due to infrequent references
by interviewees to regulative influences on action such as formal rules and policies, we propose
that the new policy alone is unlikely to motivate essential local government support.
Allocated responsibilities must align with widely-cited normative and cultural-cognitive influences,
including relationship expectations, typical processes and routines, political dynamics,
notions of identity, perceived self-efficacy, and cultural beliefs. We recommend
leveraging existing institutional influences where possible to motivate actions aligned with
the policy. For example, local government actors can fulfill community expectations of them
to solve prolonged nonfunctionality by connecting communities to professionalized maintenance
service providers instead of performing individual out-of-pocket repairs. Improving
understanding of local service authority perspectives is essential as professionalized maintenance
arrangements emerge and grow and as new policies expand and shift essential
support functions.

Cord, C., Javernick-Will, A., Buhungiro, E., Harvey, A., & Linden, K. (2022). Institutional influences on local government support for professionalized maintenance of water supply infrastructure in rural Uganda: A qualitative analysis. PLOS Water, 1(2), e0000003.

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Systems for regular, preventive maintenance of infrastructure are needed to ensure safe water access globally. Emerging and growing across rural sub-Saharan Africa, professionalized maintenance arrangements feature legal, regulated service providers who maintain infrastructure in exchange for consumer payment through contracts. However, little is understood about the conditions that enable service providers to retain consumer contracts, an important component of their sustainability that indicates consistent demand and payment. This paper uses fuzzy-set Qualitative Comparative Analysis to identify combinations of operational, natural, physical, political, and social conditions enabling high contract retention across 22 implementation cases in Uganda, uncovering 2 pathways to success. In both pathways, consistent expansion by the service provider normalizes concepts such as tariff payment and local government participation increases trust and accountability between the service provider and consumers. The predominant pathway features one additional condition, coordinated sector aid, ensuring consistent implementation and mitigating harmful dependencies. The alternative pathway relies on large user communities and ease of access to those communities to counteract uncoordinated aid. Thus, operational, social, and political conditions may be suf!cient to enable high contract retention irrespective of natural and physical conditions. This paper uncovers the combined efforts required of service providers, service authorities, international donors, and local aid actors to ensure the sustainable maintenance of rural water infrastructure for reliable safe water access.

Cord, C., Javernick-Will, A., Buhungiro, E., Harvey, A., Jordan, E., Lockwood, H., & Linden, K. (2022). Pathways to consumer demand and payment for professional rural water infrastructure maintenance across low-income contexts. Science of The Total Environment, 815, 152906.

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Water and sanitation services remain unequal, unreliable, and unsafe for too large a portion of our world's population. Challenges facing service delivery are multifaceted and intertwined, including high breakdown rates, weak or convoluted laws, insufficient financing mechanisms, and drought. Solving these challenges often falls on the shoulders of local governments, as many national governments decentralize service provision mandates. Especially in low-income and weak-governance contexts, overcoming service delivery challenges can exceed the scopes and skillsets of any single agency or department. Collaborative approaches are thus used by governments and international development actors as a way to bring all relevant, local stakeholders together to solve these problems through joint action and mutual responsibility. Understanding how collaborative approaches work in low-income and weak-governance contexts is therefore imperative to achieving universal, reliable access to safe water, sanitation, and hygiene (WASH) services.

There is a wealth of literature on collaborative approaches; however, this literature is limited in scope as nearly all published knowledge has focused on high-income country contexts. Working closely with experts from eleven cases in Eastern Africa, this dissertation investigated how collaborative approaches work in WASH contexts. I first synthesized literature and convened an expert panel to rate and prioritize factors that enable success in collaborative approaches in low-income and weak-governance contexts. To comprehensively understand how these factors worked on the ground, I used fuzzy-set Qualitative Comparative Analysis (fsQCA) to investigate combinations of factors that drove progress. Results spurred a second fsQCA investigation into the sole factor that was necessary for progress in all cases: local government uptake. Finally, in response to methodological limitations that has prevented comprehensive investigations of alignment around a common objective, I developed a new method using network analysis and used it to map how alignment changed over time in two well-functioning collaborative approaches.

Together, this dissertation provides evidence-based guidance on factors and processes that enable collaborative efforts to succeed, laying the groundwork for implementing collaborative approaches in the challenging and unique environment of WASH. Through its unique contributions, this dissertation charts a new course for more robust international development programming and theory development.

Pugel, K. (2021). "Collaboratively Strengthening Water and Sanitation Systems in Low-Income and Weak-Governance Contexts". Dissertation, ��������.

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