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Poor rural water quality is a health challenge in Fiji. A mixed-methods study in six iTaukei (Indigenous Fijian) villages was conducted to understand local perceptions of drinking water access and quality, how this changes drinking water source choices, and impacts of age and gender. Seventy-two household surveys, 30 key informant interviews (KIIs) and 12 focus group discussions (FGDs) were conducted. Household surveys revealed 41.7% of community members perceived their water as dirty and 76.4% perceived their water as clean. Two-thirds of households reported that they always or usually had enough water. FGDs and KIIs revealed water access and quality was influenced by population size, seasonality, and rainfall. Perceptions of water quality caused villages to shift to alternative water sources. Alignment of the qualitative and quantitative data identified four themes: sources and infrastructure, access, quality and contamination. There was mixed alignment of perceptions between access and quality between the household surveys, and KIIs and FGDs with partial agreement sources and infrastructure, and quality. Gender was found to influence perceptions of dirty water, contamination, and supply and demand. Perceptions of water quality and access shape decisions and choices for water sources and can be used to inform resilience and inclusive water strategies.

In Fiji, 90% of the population has access to basic sanitation; however, there are still persistent health risks from endemic faecal-oral diseases such as typhoid fever. There is a need to assess the contribution of existing sanitation facilities in the faecal pathogen transmission pathway. This study was conducted as part of a larger planetary health study across 29 rural communities within five river catchments. This specific research aimed to characterise latrine front-ends, both infrastructure and usage behaviour, and to assess the faecal contamination levels on various frequently contacted latrine surfaces in rural Fiji. A sanitation survey, along with observation and latrine swab sampling, was conducted in households over three phases: baseline ( n  = 311) (Aug–Dec 2019), endline ( n  = 262) (Jun–Sep 2022) and an in-depth front-end study ( n  = 12) (Oct–Nov 2022). Of 311 households, almost all had pedestal-type latrines, predominately cistern-flush (83%), followed by pour-flush (13%), and then hole-type (pit) latrines (4%). Washable latrine floors had significantly higher E. coli densities (6.7 × 10 2  CFU/25 cm 2 ) compared to non-washable floors (1.3 × 10 2  CFU/25 cm 2 ) ( p  = 0.05), despite washable floors indicating improved latrines. The in-depth front-end analysis found that moist latrine surfaces had significantly elevated E. coli densities (1.2 × 10 3  CFU/25 cm 2 ) compared to the dry ones (14.3 CFU/25 cm 2 ) ( p  < 0.001), highlighting the importance of maintaining dry latrine surfaces. Latrine floors and mid-walls were the most frequently contaminated surfaces, emphasising the need to clean and disinfect these surfaces. Only 46% of the households reported always using soap for handwashing after defecation, exacerbating the risk of transmitting faecal pathogens. This study highlights that latrine cleanliness and hygiene are as crucial as latrine infrastructures for the effective disruption of faecal pathogens transmission during latrine use.

Watersheds offer opportunities for place-based interventions to transform systems health via preventative versus reactive approaches to management that achieve multiple co-benefits for public and environmental health. The Watershed Interventions for Systems Health in Fiji (WISH Fiji) project embraced participatory knowledge co-production and action-oriented research to identify risks to public and ecosystem health, prioritize interventions to address risks, and monitor responses of the system to interventions. We used screening filters and local knowledge to collaboratively identify five watersheds for action with high prior incidence of water-related diseases (Fiji’s “three plagues” of leptospirosis, typhoid and dengue) and high risk to downstream environmental health. We reviewed literature to identify disease risk factors, evaluated overlaps with risks for downstream environmental impact, and designed 13 instruments to collect information about baseline risk. Following consultations to obtain free, prior and informed consent, we enrolled 311 households across 29 communities. We synthesized data to identify key risks at the household, community, and landscape level, which were communicated to community water and resource management committees and government leaders as part of developing water and sanitation safety plans for each community. Local committees identified 339 priority risk reduction actions across nine main categories: animal management; drainage; health systems surveillance; hygiene; integrated planning; land use management; sanitation systems; waste management; and water systems. As of October 2022, 154 interventions were implemented in the five watersheds across different risk categories and scales. While we can track changes to factors that reduce risk of water-related disease and improve environmental health, direct evaluation of impacts to public health is limited due to poor geolocation of case records. The WISH Fiji project is a model of cross-sectoral coordination that efficiently progresses multiple Sustainable Development Goals, but scaling requires sustained investment in interventions to realize full benefits, particularly for nature-based solutions that exhibit lagged responses.