The influence of seasonality and multiple water source use on household water service levels

Universal access to safely managed drinking water (SMDW) is important for human health, well-being, and development. It is reflected in Sustainable Development Goal (SDG) 6. In rural areas of low- and middle-income countries, 1.9 billion people lack access to SMDW. Multiple water source use and seasonal source switching may negate health and development gains from SMDW. Hence, achieving SDG 6 requires a better understanding of how these factors relate to household service levels. We explored this using data from 37,105 household surveys and 6395 household drinking water samples collected from rural areas of 14 low- and middle-income countries (Ethiopia, Ghana, Honduras, India, Kenya, Malawi, Mali, Mozambique, Niger, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe). A different primary water source was used in the rainy and dry seasons by 10% of households; seasonal source switching was most common in Kenyan households (29%) and least common in Zambian households (3%). Twenty-three percent of households used a secondary water source, and 37% of these secondary sources were unimproved (e.g., unprotected dug wells and surface water). Sixty-nine percent of household water samples contained E. coli. In 11 of 14 countries studied, fecally contaminated water was the water service parameter preventing households from having SMDW free from fecal contamination at the point of use. Overall, 7% of households had access to SMDW free from contamination at the point of use. Our results confirm that the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation, and Hygiene (JMP) substantively overstate the population benefiting from safely managed drinking water, and their reporting statistics should be interpreted with caution. Seasonal source switching and secondary water source use have an important influence in some countries and should be accounted for in monitoring and programming activities.