A hidden crisis: strengthening the evidence base on the current failure of rural groundwater supplies

New ambitious international goals for universal access to safe drinking water depend critically on the ability of development partners to accelerate and sustain access to groundwater. However, available evidence (albeit fragmented and methodologically unclear) indicates >30% of new groundwater-based supplies are non-functional within a few years of construction. Critically, in the absence of a significant systematic evidence base or analysis on supply failures, there is little opportunity to learn from past mistakes, to ensure more sustainable services can be developed in the future. This work presents a new and robust methodology for investigating the causes of non-functionality, developed by an interdisciplinary team as part of a UK-funded development research project. The approach was successfully piloted within a test study in NE Uganda, and forms a basis for future research to develop a statistically significant systematic evidence base to unravel the underlying causes of failur

UPGro Hidden Crisis Research Consortium. Survey 1 Country Report, Uganda

Statistics on the functionality of water points from the Hidden Crisis project in Uganda are presented. The survey, undertaken in 2016, was focussed on boreholes equipped with handpumps (HPBs) within the 112 districts of Uganda. A stratified two stage random sampling approach was adopted and 10 districts identified to sample. A tiered definition of functionality was applied, and all which enabled more nuanced definitions to be reported: The results from the survey indicate: • 55% of HPBs were working on the day of the survey (compared to national figure of 86% for rural water supply ) • 34% of HPBs passed the design yield of 10 litres per minute • 23% passed the design yield and also experienced < 1 month downtime within a year. • 18% passed the design yield and reliability criteria and also water quality criteria The results of the survey indicate the utility of carrying out more detailed assessments of functionality to help unpack national statistics. A linked survey of the performance of the water management arrangements at water points showed that for 70% of the sites water management arrangements were judged to be weak

Gaps in COPD guidelines of low- and middle-income countries: a systematic scoping review

BACKGROUND: Guidelines are critical for facilitating cost-effective COPD care. Development and implementation in low-and middle-income countries (LMICs) is challenging. To guide future strategy, an overview of current global COPD guidelines is required. RESEARCH QUESTION: We systematically reviewed national COPD guidelines, focusing on worldwide availability and identification of potential development, content, context and quality gaps that may hamper effective implementation. STUDY DESIGN: & Methods: Scoping review of national COPD management guidelines. We assessed: (1) global guideline coverage, (2) guideline information (authors, target audience, dissemination plans), (3) content (prevention, diagnosis, treatments), (4) ethical, legal, socio-economic aspects and (5) compliance with the eight Institute of Medicine (IOM) guideline standards. LMICs guidelines were compared to those from high-income countries (HICs). MAIN RESULTS: Of the 61 national COPD guidelines identified, 30 were from LMICs. Guidelines did not cover 1.93 billion (30.2%) people living in LMICs, whereas only 0.02 billion (1.9%) in HICs were without national guidelines. Compared with HICs, LMIC guidelines targeted fewer healthcare professional groups and less often addressed case finding and co-morbidities. Over 90% of all guidelines included smoking cessation advice. Air pollution reduction strategies were less frequently mentioned in both LMICs (47%) and HICs (42%). LMIC guidelines fulfilled on average 3.37 (42%) of IOM standards compared to 5.29 (66%) in HICs (p<0.05). LMICs scored significantly lower compared with HICs regarding conflicts of interest management, updates, articulation of recommendations and funding transparency (all, p<0.05). INTERPRETATION: Several development, content, context and quality gaps exist in COPD guidelines from LMICs that may hamper effective implementation. Overall, COPD guidelines in LMICs should be more widely available and should be transparently developed and updated. Guidelines may be further enhanced by better inclusion of local risk-factors, case finding and co-morbidity management, preferably tailored to available financial and staff resources

A hidden crisis: strengthening the evidence base on the current failures of rural groundwater supplies

New ambitious international goals for universal access to safe drinking water depend critically on the ability of development partners to accelerate and sustain access to groundwater. However, available evidence (albeit fragmented and methodologically unclear) indicates >30% of new groundwater-based supplies are non-functional within a few years of construction. Critically, in the absence of a significant systematic evidence base or analysis on supply failures, there is little opportunity to learn from past mistakes, to ensure more sustainable services can be developed in the future. This work presents a new and robust methodology for investigating the causes of non-functionality, developed by an interdisciplinary team as part of an UPGro catalyst grant. The approach was successfully piloted within a test study in NE Uganda, and forms a basis for future research to develop a statistically significant systematic evidence base to unravel the underlying causes of failure

UPGro Hidden Crisis Research Consortium : project approach for defining and assessing rural water supply functionality and levels of performance

This technical brief is aimed at sharing the learning and approaches developed by the UPGro Hidden Crisis Research Project to look at how the functionality and performance levels of boreholes equipped with handpumps (HPBs), can be assessed using a common set of definitions and methods. A tiered approach to defining and measuring functionality is found to be useful to examining functionality for different scales and purposes of monitoring. This report is aimed at national and regional actors involved in the provision and monitoring of rural water supply functionality. The brief sets out the tiered functionality definitions, and accompanying survey methods, which were developed by the project and have been applied in functionality surveys across Ethiopia, Uganda and Malawi [5-7]. The brief provides a summary of: • The tiered approach to defining and measuring the functionality and performance levels of boreholes equipped with handpumps (HPBs). • A series of survey methods which were found to be useful by the Hidden Crisis project to collect sufficient data to assess HPB functionality across the tiered definition approach. • A series of guidelines which could form core criteria for assessing functionality and performance levels of water points . This summary should be read in conjunction with the appendices which provide details of the methods and approaches described