UC Berkeley

Over two billion people globally lack access to safe water. This is both a public health problem and a violation of human rights. The United Nations Sustainable Development Goals, through its ambitious and human-rights based framework, and the safe water, sanitation, and hygiene (WASH) community, through its calls for "transformative WASH," have signaled that status quo interventions will not achieve universal safe water access goals. Rather, there is a need for new pathways toward the progressive realization of the human right to available, safe, acceptable, accessible, and affordable water for all. In Chapter 1, I present the results of a systematic review of adherence to chlorine point-of-use (POU) water treatment at the household-level, a widely promoted and inexpensive strategy for improving drinking water quality and health. While centralized chlorination of urban piped water supplies has historically contributed to major reductions in waterborne illness, sub-optimal adherence to household-level water treatment indicates that chlorine POU products are unlikely to lead to the widespread public health benefits associated with centralized treatment of piped water supplies. In Chapter 2, I present the results of an evaluation of system-level, passive chlorination technologies in small water systems in rural Nepal. These passive chlorination technologies have the potential to automatically treat water, without requiring the household-level behavior changes that are required for POU products. While these technologies have been rigorously evaluated as decentralized treatment solutions in some urban settings, little data exist on their performance in remote, rural systems, for which these technologies can serve as fully centralized chlorination systems. Over one year, we found that these technologies significantly improve the quality of water accessed by households. While service delivery models should be explored to ensure long-term sustainability, passive chlorination technologies have the potential to radically improve how rural households gain access to safe water. In Chapter 3, I present a synthesis of the literature at the intersection of gender and domestic water. The vast water and health literature is overwhelmingly focused on the consequences for child health, while focusing less attention on the health of the water carriers and managers, the women and girls who are typically the implementers of household-level treatment strategies. Yet, failing to understand the full consequences for women and girls leaves a major gap in our accounting of the value of accessible and safe water and cannot lead to gender equality.