Review of drivers and barriers of water and sanitation policies for urban informal settlements in low-income and middle-income countries

Abstract Background There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs). This is despite such settings accounting for a high burden of disease. Many factors intersect to influence the performance of CHVs working in urban informal settlements in LMICs. This review was conducted to identify both the programme level and contextual factors influencing performance of CHVs working in urban informal settlements in LMICs. Methods Four databases were searched for qualitative and mixed method studies focusing on CHVs working in urban and peri-urban informal settlements in LMICs. We focused on CHV programme outcome measures at CHV individual level. A total of 13 studies met the inclusion criteria and were double read to extract relevant data. Thematic coding was conducted, and data synthesized across ten categories of both programme and contextual factors influencing CHV performance. Quality was assessed using both the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Assessment Tool (MMAST); and certainty of evidence evaluated using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. Results Key programme-level factors reported to enhance CHV performance in urban informal settlements in LMICs included both financial and non-financial incentives, training, the availability of supplies and resources, health system linkage, family support, and supportive supervision. At the broad contextual level, factors found to negatively influence the performance of CHVs included insecurity in terms of personal safety and the demand for financial and material support by households within the community. These factors interacted to shape CHV performance and impacted on implementation of CHV programmes in urban informal settlements. Conclusion This review identified the influence of both programme-level and contextual factors on CHVs working in both urban and peri-urban informal settlements in LMICs. The findings suggest that programmes working in such settings should consider adequate remuneration for CHVs, integrated and holistic training, adequate supplies and resources, adequate health system linkages, family support and supportive supervision. In addition, programmes should also consider CHV personal safety issues and the community expectations.

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Impact of the aquatic pathobiome in low-income and middle-income countries (LMICs) quest for safe water and sanitation practices

Current Opinion in Biotechnology ◽

10.1016/j.copbio.2021.08.015 ◽

2022 ◽

Vol 73 ◽

pp. 220-224

Author(s):

Elisa Taviani ◽

Olivia Pedro

Keyword(s):

Low Income ◽

Water And Sanitation ◽

Middle Income ◽

Safe Water ◽

Middle Income Countries

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Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17

The Lancet Global Health ◽

10.1016/s2214-109x(20)30278-3 ◽

2020 ◽

Vol 8 (9) ◽

pp. e1162-e1185 ◽

Cited By ~ 3

Author(s):

Aniruddha Deshpande ◽

Molly K Miller-Petrie ◽

Paulina A Lindstedt ◽

Mathew M Baumann ◽

Kimberly B Johnson ◽

...

Keyword(s):

Drinking Water ◽

Low Income ◽

Water And Sanitation ◽

Middle Income ◽

Middle Income Countries ◽

Geographical Inequalities

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How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

BMJ Open ◽

10.1136/bmjopen-2021-053320 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053320

Author(s):

Sarah Nelson ◽

Dorothy Drabarek ◽

Aaron Jenkins ◽

Joel Negin ◽

Seye Abimbola

Keyword(s):

Community Participation ◽

Low Income ◽

Community Dynamics ◽

Realist Review ◽

Eligibility Criteria ◽

Water And Sanitation ◽

Middle Income ◽

Middle Income Countries ◽

Community Water ◽

Contextual Elements

ObjectiveTo understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.DesignRealist review.Data sourcesPubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.Eligibility criteria for selecting studiesCriteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).AnalysisInductive and deductive coding was used to generate context–mechanism–outcome configurations.Results73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one’s behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation.ConclusionsThe findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.

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