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Abstract Rural women are considered a healing resource because they manage health problems of their family and community. On the other hand, their own cares are neglected. Based on the experience of women in rural areas, this study adopts an intersectional perspective to understand the relation between social markers of difference and health vulnerability in rural women in Zona da Mata in Minas Gerais. In total, 20 women aged 18 to 73 years were interviewed in 2022. Data were qualitatively analyzed and categorized by content analysis. This research highlights the inequities regarding access to health in rural areas (including the inadequacy of basic sanitation) and the need for an intersectional approach to collective health analysis. Resumo Mulheres rurais são consideradas recurso um de cura por encaminharem os problemas de saúde da família e comunidade, mas, por outro lado, acabam sendo negligenciadas do cuidado. Baseado na experiência das mulheres nos territórios rurais, este estudo adota a perspectiva interseccional para entender a relação dos marcadores sociais da diferença e a vulnerabilidade em saúde das mulheres rurais da Zona da Mata de Minas Gerais. Foram entrevistadas 20 mulheres, entre 18 e 73 anos, em 2022. Os dados produzidos foram analisados qualitativamente e categorizados pela metodologia de análise de conteúdo. A pesquisa evidencia a falta de equidade quanto ao acesso à saúde no meio rural, incluindo a pouca adequação do saneamento básico, e a necessidade da abordagem interseccional para análises em saúde coletiva.

Water and sanitation are core for the growth and development of communities. Yet, South African local municipalities are often unable to sustainably deliver safe water and basic sanitation for all. Drawing on perspectives of ecological economics, this study analysed the sustainability of water and sanitation systems in rural communities of the Lepelle Nkumpi Local Municipality. Mixed research approach was used to collect the data from 657 household and institutional respondents. The study found that households used water for multi-purposes including consumptive, productive and domestic, but existing facilities are in deplorable condition. Pollution arising from agrochemicals, waste systems, mining, sewerage, and industrial effluence significantly affected water systems in the communities. Bridging demand–supply gaps require initiatives like bulk water supply and implementation of the free basic water policy in underprivileged areas. Tariffs should either be waived or adjusted for extremely poor households. Waste management initiatives, like capacity building, public education, investments, and facility upgrade, could help avert spread of waterborne infections and improve the resident’s health.

A major challenge confronting most countries in the world including those in Africa, is lack of access to basic drinking water and sanitation. This has given birth to several studies investigating the factors that influence access to basic drinking water and sanitation. Notwithstanding, while financial inclusion is highly extolled for its welfare-enhancing effects and hence could play a major role in accessing basic drinking water and sanitation services, there is a dearth of empirical evidence in this regard, especially in the African context. This study, therefore, attempts at providing the foremost empirical evidence of the effect of financial inclusion on access to basic drinking water and sanitation in Africa using a sample of 33 countries for the period 2004 to 2018. The random effects and the fixed effects regressions are used as baseline estimation techniques and the Instrumental Variable Fixed Effects (IVFE) regression is employed as a robustness check. Our findings show that, financial inclusion enhances access to basic drinking water and sanitation services, irrespective of the estimator used. The implication is that, expanding financial inclusion can be used as an effective strategy towards enhancing access to basic drinking water and sanitation services in Africa.

Objective: Analyze the benefits of adopting total quality in a water supply company, aiming to improve service quality and customer satisfaction.   Theoretical Framework: A literature review was conducted as a basis for understanding the key concepts of TQM, the dimensions of service quality, and the essential elements for the successful implementation of TQM in the context of the analyzed company.   Method: The research is classified as a case study with an applied qualitative approach. To achieve the proposed objectives, techniques such as documentary research, literature review, semi-structured interviews, and direct observation were used.   Results: The analysis of the results demonstrated that the water supply company faces significant challenges regarding service quality. From the TQM approach, opportunities for improvement were identified in different areas of the organization, both in the reliability of the services' outcomes, including the water treatment process and maintenance of the distribution network, and in customer service.   Research Implications: The research suggests that the water supply company should adopt TQM as a strategy to improve service quality, promote customer satisfaction, address internal challenges, and seek constant improvement.   Originality/Value: The study explores the application of TQM in a public service context, providing practical guidance and insights to improve service quality in a water supply company, with implications that may extend to similar organizations seeking to enhance their services and processes.

Through the Free Basic Sanitation (FBSan) service policy, many informal settlements in South Africa have been provided with basic sanitation facilities. However, access to these facilities remains challenging for many residents. These challenges have compelled residents to adopt a range of alternative sanitation practices. Through interviews, observation and focus group discussions in five informal settlements in the Western Cape, South Africa, 383 randomly selected respondents identified factors that shape their sanitation practices and how these practices impact on access to, and sustainability of sanitation services in the policy context of the FBSan. Residents' sanitation practices include the use of buckets, porta-potties, plastic bags, and existing facilities within and outside their settlements for either defecating or discharging the bucket contents and open defecation. These sanitation practices are informed by factors including safety concerns, poor conditions of the facilities, lack of privacy and choice. These findings suggest that the provision of facilities through the FBSan policy should consider the multiple and varied needs of residents, practices and conditions of their settlements prior to the selection and deployment of facilities to informal settlements in South Africa.

Shared sanitation facilities are not considered as basic sanitation owing to cleanliness and accessibility concerns. However, there is mounting evidence that some shared household toilets have a comparable level of service as private toilets. This study examined the factors that contribute to the quality of shared household toilets in low-income urban communities in Ghana and Kenya. The study design comprised household surveys and field inspections. Overall, 843 respondents were interviewed, and 838 household shared sanitation facilities were inspected. Cleanliness scores were computed from the facility inspections, while a total quality score was calculated based on 13 indicators comprising hygiene, privacy, and accessibility. Regression analyses were conducted to determine predictors of cleanliness and the overall quality of the shared sanitation facilities. More than four out of five (84%) shared toilets in Ghana (N = 404) were clean, while in Kenya (N = 434), nearly a third (32%) were clean. Flush/pour-flush toilets were six times (p < 0.01 aOR = 5.64) more likely to be clean. A functional outside door lock on a toilet facility and the presence of live-in landlords led to a threefold increase (p < 0.01 aOR = 2.71) and a twofold increase (p < 0.01 aOR = 1.92), respectively in the odds of shared sanitation cleanliness. Sanitation facilities shared by at most five households (95% CI: 6–7) were generally clean. High-quality shared toilets had live-in landlords, functional door locks, and were water-dependent. Further studies on innovative approaches to maintaining the quality of these high-quality shared toilets are needed to make them eligible for classification as basic sanitation considering the increasing reliance on the facilities.

This study provides evidence of targeting the performance of subsidies and affordability of water supply services (WSS) in a low-income society marked by disparate socioeconomic indicators. We used sample microdata from the local census regarding income, as well as information about price, tariff structure, water consumption, distribution of consumer units by billed volume ranges, and the average cost of WSS by the service areas (SA) in the Federal District, Brazil, in 2019 and 2020/2021, periods in which there was a transition from the tariff methodology. The results showed average water consumption of 108 L.inhabitant−1. day−1 and 399 L.inhabitant−1. day−1 in the lower and higher-income areas, respectively. Customers with a monthly consumption of less than 27 m3 were subsidized in both tariff cycles. The distribution of subsidies was regressive according to the connection and consumption index in the SA of lower income. Approximately a quarter of the families in the lowest income regions commit more than 3% of their income to consume water in the lifeline block of the WSS tariff structure. Findings also indicate that poorer households headed by women with children are more likely to have water poverty problems.

This study aims to evaluate the level of technical efficiency of companies that perform the integrated management of basic sanitation in Brazilian municipalities. A Multiple Data Envelopment Analysis (M-DEA) model was applied to estimate the performance of water supply and sewage services in 1628 municipalities covering more than 56% of the Brazilian population, identifying the factors that most influence the efficiency of the sector in the years 2008 and 2016. The M-DEA methodology is an extension of Data Envelopment Analysis (DEA) with multiple DEA executions considering all combinations of inputs and outputs to calculate efficiency scores. The methodology reduces possible biases in the selection of resources and products of the model, ability to support decision-making in favor of improvements in the sector′s efficiency based on national regulatory framework. The analyses show that the companies analyzed can increase their operating results and attendance coverage by more than 60%, given the current levels of infrastructure, human and financial resources in the sector. Based on the simulation of potential efficiency gains in Brazilian basic sanitation companies, the estimates show that the coverage of the population with access to sanitary sewage would go from the current 59.9% to 76.5%. The evidence found provides indications to subsidize sanitation management in the country at the micro-analytical level, enabling a better competitive position in the sector for the integrated management of basic sanitation and its universalization in Brazil.

The objective of this study is to provide a view of the geographic distribution of basic sanitation services offered in Parana, Brazil. Temporal distributions, spatial patterns, and clusters were determined using 2000, 2010, and 2016 data. Tabular data of the percentages of households receiving water supply, waste collection, and sanitary sewage treatments were used as the basic inputs of the study. Time series maps were created using geographic information systems (GIS) for the visualization of the temporal changes in basic sanitation rates. The spatial variation in sanitation services was measured using Moran’s Global Index (Moran’s I), while the Local Indicators of Spatial Association (LISA) and Getis-Ord Gi* (d) were used to identify the presence of possible clusters and hot spots in the percentage of households with sanitation services. The study showed strong evidence that the service rates for sanitary sewage were significantly lower than those for water supply and waste collection. Waste collection proved to have the highest service rate in the study area. Waste collection was also the service that increased the most in the study period, followed by the water supply service. Identification of the most vulnerable municipalities was performed using LISA and the local Getis-Ord Gi* (d) statistic. Most of the low value clusters and cold spots were detected in the southern and west-central regions, while the high value hot spots and clusters were detected in the northern and northeastern regions of the state of Parana.

Improved WASH facilities are crucial for reducing infectious diseases such as diarrhoea, malaria, dengue, and worms, etc. However, a large proportion of households in developing countries lack basic WASH facilities. Therefore, the current paper uses the household data from 733,223 households in fourty two developing countries to explore the prevalence rate of basic WASH facilities. The result shows that access to basic drinking water is much better than access to other WASH facilities, such as basic sanitation and hygiene facilities. However, the prevalence of basic drinking water, basic sanitation, and basic hygiene vary across different regions and countries-low in Africa and South Asia. The multi-level regression model shows that households with better economic status and education and urban households are more likely to use basic WASH facilities. Further, women empowerment and already having one WASH practice are also positively associated with the adoption of other WASH facilities. The policy should aim at improving awareness about the benefit of WASH facilities through education, and it should also subsidize WASH facilities for poor households and those living in rural areas.