Abstract
The risk-based approach to drinking-water safety management has been widely adopted within the water sector since 2004 when the World Health Organisation (WHO) championed the use of Water Safety Plans (WSPs) as a comprehensive risk assessment and risk management approach that encompasses all steps in water supply from catchment to consumer. Due to the high resource requirements for full WSP implementation, an alternative risk assessment approach is required where WSP rollout is either not feasible or warranted, which is often especially pertinent within small drinking-water supplies.
Sanitary inspections (SIs), which typically consist of a set of questions to identify observable breakdowns in supply protection; and sources and pathways of contamination, may serve numerous functions including use within the WSP of a large supply; as a basic or introductory WSP for a small supply; and as a tool for water safety surveillance activities. The use of risk assessments within the drinking-water sector is not novel, however the first suite of global SI templates was published just 24 years ago in the 1997 WHO Guidelines for Drinking-water Quality (GDWQ). With the impending publication of the subsequent edition of these GDWQ, which are often used to guide development of regulations such as the new European Union (EU) Drinking-water Directive (DWD), review of the content and format of the SI forms to be included within the revised publication was timely.
This study used a mixed methods approach to improve SIs for small drinking-water supplies. In addition to the rigorous review and revision of the WHO SI forms based on literature review; group discussion; and expert and practitioner review, additional research questions relating to the consistency of SI answering between cohorts; the effect of training on SI answer consistency; approaches to SI adaptation; and the impacts related to SI implementation were all tested and investigated using qualitative and quantitative methods both online and during field studies in Iceland, Malawi and Uganda.
The main contribution to the literature stemming from this research, which demonstrates the originality, rigour, and significance of the work, will be the publication of the revised suite of SI forms in the new WHO GDWQ. These resources will be used widely for practical implementation of risk assessments either by direct use of the WHO templates, or by use as a reference point for adaptation. The research related to SI adaptation undertaken during this study will provide an initial point of reference for those endeavouring to adapt or develop their own SI materials.
The main limiting factor of each individual research objective was the use of small sample sizes, which was due to restricted PhD study resources. The future advancement of SIs will rely heavily on their digitalization. SI forms that can be adapted in real-time to adjust to unique supply circumstances or configurations, or that guide inspectors who possess low levels of knowledge by showing interactive examples of operational definitions or risks, are examples of how technology could further improve the SI approach. Considering the potential for software to recognise that, for example, certain combinations of risk factors and metadata, such as rainfall, may cause an increased threat to water quality, the SI may soon become the most powerful tool for drinking-water management and surveillance.