Evaluating a Water Safety Plan Intervention in Ghana

Free chlorine residue in water at point of collection (public standpipes and private taps) at or above target level of 0.2 mg/L, and at or above detectable level of 0.1 mg/L

E. coli in water at point of collection (binary and categorical)

Total coliform in water at point of collection (binary)

Turbidity measured in NTU in water at point of collection

Reliability/availability of water based on (1) service provider documented interruptions, and (2) consumer reported service interruptions

Household respondent satisfaction with water supplier. They will be considered satisfied if they report they are either satisfied or very satisfied with the water supplier. They will be considered dissatisfied if they report they are either dissatisfied or very dissatisfied with the water supplier.

Household use of enrolled piped water system for drinking (binary).

Household respondents report water quality issues with the taste, odor, or appearance of supplied water.

Number of complaints regarding the service or quality of water. This will be measured based on (1) household self-reporting, and (2) water system reports or records.

Prevalence of reported diarrhea in the past two weeks. Diarrhea is defined as 3 or more loose or watery stools within 24 hours. Measured for a household's youngest child <5 years old, and any household member showing symptoms.

Prevalence of reported blood in stool in the past two weeks. Measured for a household's youngest child <5 years old, and any household member showing symptoms.

Prevalence of reported severe diarrhea in the past two weeks. Defined as having a fever and either diarrhea or blood in stool. Measured for a household's youngest child <5 years old.

Prevalence of reported severe or non-severe acute respiratory infection (ARI) in the past two weeks. A severe ARI is defined as having a fever and either a cough or difficulty breathing. A non-severe ARI is defined as having a cough or difficulty breathing. Measured for a household's youngest child <5 years old.

Clinical visits will be assessed based on (1) the number of clinic visits reported by households for diarrhea-related illness, and (2) records for the number of cases of water-related illness in patients who visited healthcare facilities serving the included communities.

E. coli in stored household water at point of consumption (binary and categorical)

Total coliform in stored household water at point of consumption (binary)

Free chlorine residue in stored household water at point of consumption at or above target level of 0.2 mg/L, and at or above detectable level of 0.1 mg/L

Total chlorine residue in stored household water at point of consumption at or above target level of 0.2 mg/L, and at or above detectable level of 0.1 mg/L

Number of risk factors identified by sanitary inspections of water system infrastructure including the water source, water tank, distribution system, and standpipes.

Quality and use of written documentation for water system management including an operational monitoring plan, compliance monitoring plan, standard operating procedures, troubleshooting manual, maintenance schedule, and operator training program. It will be assessed whether written documentation exists, and if yes, whether it is detailed or incomplete and lacking detail. Water operators will also report if the written procedures are fully implemented in practice or not. This is intended to evaluate the professionalization and management of the water systems.

Financial sustainability/cost recovery (ratio of revenue collected to operating costs) of the system

(1) Number of internal and external water safety meetings, and (2) Number of consumer water safety training or awareness events

Documentation of climate related risks and response including whether climate-related information for the water supply system has been identified and documented, climate-related hazards related to events like heavy rainfall, flooding, and drought have been identified and prioritized, and an emergency response plan has been prepared. It will be assessed whether each aspect has been completed, and if yes whether it has been partially undertaken, but not documented; or fully undertaken and documented.

Identification of disadvantaged groups in the water service area has been completed by the water supplier and they have been prioritized for participation or the service provider has made improvements to the water system to address inequalities between disadvantaged and non-disadvantaged groups. It will be assessed whether each aspect has been completed, and if yes whether it has been partially undertaken, but not documented; or fully undertaken and documented.