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Dominant development discourse holds that water scarcity reflects geophysical limitations, lack of infrastructure or lack of government provision. However, this paper outlines the ways in which scarcity can only be fully explained in the context of development, specifically, neoliberal economic policies and related notions of good governance. Water is Lesotho’s primary natural resource, yet many of its inhabitants remain severely water insecure. Presently, decentralization and Integrated Water Resource Management (IWRM) are embraced in Lesotho as a philosophy and method to engage varied stakeholders and to empower community members. Using a water committee in Qalo, Lesotho as a case study, this paper explores the micro-politics of water governance. As individuals contest who is responsible for managing water resources for the village—by aligning themselves with traditional chiefs, elected officials, or neither—they transform or reinforce specific hydro-social configurations. While decentralized resource management aims to increase equity and local ownership over resources, as well as moderate the authority of traditional chiefs, water access is instead impacted by conflicts over management responsibility for water resources. Drawing on theories of political ecology and governmentality to extend recent scholarship on IWRM, this paper re-centers the political in water governance by situating local tensions within national policies and development agendas and demonstrating how scarcity is hydro-social.

Syndemic theory considers how social inequalities drive disease interaction. A new study uses a mixed-methods approach to examine how stress interacts with multiple diseases to affect quality of life in Soweto, South Africa.

Achieving the United Nations Sustainable Development Goals (SDGs) requires effective changes in multiple sectors including education, economics, and health. Malawi faces challenges in attaining the SDGs in general, and specifically in the sanitation sector. This paper aims to describe the existing landscape within public universities in Malawi to build a framework for training a cadre of locally trained experts. This is achieved by reviewing science, technology, engineering, and mathematics (STEM) degree programmes and assessing the extent of inclusion of sanitation education. The historical compartmentalization of academic programmes has resulted in few programmes to build on. Deliberate investment is needed to build from the current STEM higher education landscape to an effective framework for training sanitation experts, especially female experts. For low-income countries such as Malawi, a cadre of ~17,600 locally trained sanitation experts may be needed, for which the current higher education landscape is not sufficient. Using the Centre of Excellence in Water and Sanitation at Mzuzu University in Malawi as a case study, this paper provides a model of sanitation education in low-income countries that: 1) provides an effective complementary contribution to delivering sanitation education; 2) links to overall SDGs, national policy, university goals, and localized needs; and 3) engages students, faculty, and communities in local research.

IntroductionWater insecurity–the inability to access and benefit from affordable, reliable and safe water for basic needs–is a considerable global health threat. With the urgent need to target interventions to the most vulnerable, accurate and meaningful measurement is a priority. Households use diverse strategies to cope with water insecurity; however, these have not been systematically characterised nor measured. The Food Insecurity Coping Strategies Index has been insightful for targeting nutrition interventions to the most vulnerable. As a first step towards creating an analogous scale for water, this study characterises the largest empirical data set on water insecurity coping strategies and proposes guidance on measuring it using a novel toolkit.MethodsOpen-ended responses on water insecurity coping (n=2301) were collected across 11 sites in 10 low- and middle-income countries in the Household Water InSecurity Experiences (HWISE) Scale validation study. Responses were characterised and compared with behaviours identified in the literature to construct an instrument to systematically assess coping.ResultsWe identified 19 distinct strategies that households used when experiencing water insecurity. These findings, paired with prior literature, were used to develop a Water Insecurity Coping Strategies Assessment Toolkit with guidance on its piloting to assess coping prevalence, frequency and severity.ConclusionsThe widespread occurrence of water insecurity coping strategies underscores the importance of understanding their prevalence and severity. The Water Insecurity Coping Strategies Assessment Toolkit offers a comprehensive approach to evaluate these strategies and inform the design and monitoring of interventions targeting those most vulnerable to water insecurity.

ObjectiveProgress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.MethodsCross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use and storage; household food insecurity and perceived stress. We retained water insecurity items that were salient and applicable across all sites. We used classical test and item response theories to assess dimensionality, reliability and equivalence. Construct validity was assessed for both individual and pooled sites using random coefficient models.FindingsTwelve items about experiences of household water insecurity were retained. Items showed unidimensionality in factor analyses and were reliable (Cronbach’s alpha 0.84 to 0.93). The average non-invariance rate was 0.03% (threshold <25%), indicating equivalence of measurement and meaning across sites. Predictive, convergent and discriminant validity were also established.ConclusionsThe HWISE Scale measures universal experiences of household water insecurity across low-income and middle-income countries. Its development ushers in the ability to quantify the prevalence, causes and consequences of household water insecurity, and can contribute an evidence base for clinical, public health and policy recommendations regarding water.

New metrics of household water insecurity have been validated for low- to middle-income countries, but it is unclear how these measurements apply to the experiences of people living in high-income countries. This project aims to develop and validate a novel metric for household water insecurity experiences in the United States (HWISE-USA) using a cross-sectional design and data from the Southwest, Midwest, and Western regions. We outline the protocol for the development and validation of a novel household water insecurity scale for the United States to address this scientific need, including the following key steps: (1) item development through literature and theory; (2) pre-testing of items and expert review; (3) scale development and item reduction; and (4) scale validation. To assess the performance of the HWISE-USA scale, we will follow the same scale development analytics on a separate, quasi-nationally-representative U.S. sample. The scale will be generated from household survey data collected from communities at risk of water insecurity throughout the United States. We explain how a novel metric of water insecurity experiences for households in the United States has important implications for resource allocation, structural interventions, public health and infrastructure planning, and reductions in inequalities. osf.io/zvqs4.

Water security requires not only sufficient availability of and access to safe and acceptable quality for domestic uses, but also fair distribution within and across populations. However, a key research gap remains in understanding water security inequality and its dynamics, which in turn creates an impediment to tracking progress towards sustainable development. Therefore, we analyse the inequality of water security using data from 7603 households across 28 sites in 22 low- and middle-income countries, measured using the Household Water Insecurity Experiences Scale. Here we show an inverted-U shaped relationship between site water security and inequality of household water security. This Kuznets-like curve suggests a process that as water security grows, the inequality of water security first increases then decreases. This research extends the Kuznets curve applications and introduces the Development Kuznets Curve concept. Its practical implications support building water security and achieving more fair, inclusive, and sustainable development. A new study considering data from 7603 households across 28 sites in 22 low- and middle-income countries show that inequality of household water security follows a Development Kuznets Curve.

IntroductionA wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.Methods and analysisAfter domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups.Ethics and disseminationStudy activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful.