Assessing inequalities in sustainable access to improved water services using service level indicators in a rural municipality of South Africa

Sustainable access to improved water services in rural communities contributes to enhanced public health, wellbeing, and livelihoods and the attainment of the human right concerning access to water for all (Kayser et al. 2013). In the context of this study, sustainable access to improved water service refers to water service constituting sufficient, affordable, reliable, and continuous supply of potable water daily (Lestera & Rhiney 2018). Improved water services are provided by Improved Water Sources (IWS) (e.g. standpipe in the dwelling or communal standpipe). This is why through the Sustainable Development Goals (SDG), the target is to attain universal access to IWS by 2030 (WHO/UNICEF 2019). Substantial progress has been made in attaining the SDG target. However, a significant proportion of the rural population still does not have access to improved water services (Martinez-Santos 2017), especially in developing and underdeveloped countries.

In South Africa, the Free Basic Water (FBW) policy was implemented in the early-2000s to attain the human right to ‘sufficient water for all’. The policy outlines six recommended standards to guide water services provision, especially in rural communities. The six standards are: (i) distance – 200 meters from households within the community, (ii) water quantity – supply 25 litres/capita/day, (iii) water quality – the water should meet standards for human consumption, (iv) water delivery – a minimum of 10 litres/minute, (v) reliability of 98% (available 350 days in a year), and (vi) cost – for free (DWAF 2002; DWA 2003, 2017). The FBW policy has been praised for its progressive nature and rights-based approach in water service provision. This is also because the FBW policy was ahead of its time. At the time of implementation of the policy, the Millennium Development Goals aimed to halve the proportion of the population without access to improved water services. It is only in 2015 that the SDG targeted attaining universal access to improved water services (WHO/UNICEF 2018); aligned to the FBW policy.

Progress has been made in the implementation of the FBW policy. However, there are challenges concerning how progress in implementing the policy is monitored to inform planning and management of improved water services. The challenges are related to the indicator(s) and information used to monitor universal access to improved water services (Martinez-Santos 2017). The indicators used monitor the IWS provided to a certain proportion of the population, assuming that they provide improved water services throughout their useful lives. Multiple aspects of sustainability (e.g. physical accessibility, quantity, reliability, water quality, and affordability) that reflects the level of improved water services provided over time are not monitored. This presents a gap in the availability of relevant national and sub-national data representing inequalities in access to improved water services. Water services providers can use such data to inform planning, management and formulation of evidence-based policies and strategies to ensure sustainable access to improved water services. The use of ‘have’ and ‘have not’ approach is only useful in identifying and communicating trends in water sources provided (Kayser et al. 2013), and does not reflect the level of improved water services provided. This is because IWS fail, resulting in households not experiencing the intended level of improved water services over time, posing a threat to rural communities' livelihoods and wellbeing (Pullan et al. 2014; Martinez-Santos 2017).

Researchers have reported failures of IWS resulting from a single or multiple aspect(s) that define water service provision (Majuru et al. 2012; Martinez-Santos 2017; Sambo et al. 2018). However, this is not captured in the current monitoring system, as it does not account for the dynamic nature of water services provision. It is, therefore, crucial to adopt a practice to monitor multiple aspects that define sustainable access to improved water services to ensure the intended level of service is sustained. Kayser et al. (2013) recommend using a set of indicators that monitor the sustainability of improved water services to overcome the shortcoming presented by the current monitoring system. The indicators should consider physical accessibility, quantity, reliability, water quality, and affordability to reflect the level of improved water services provided (Kayser et al. 2013).

Water services policies adopted at global and domestic levels can provide a set of indicators to monitor sustainable access to improved water services (Kayser et al. 2013). The use of a set of indicators to monitor water services is not recent; it was first introduced in 1991 by Lloyd & Bartram (1991) with the view that increased coverage in access to IWS should also reflect the level of improved water services provided. Lloyd & Bartram (1991) then proposed a surveillance strategy in the form of a framework based on a set of indicators to monitor progressive improvement in water services. The strategy proposed five indicators: coverage, continuity, quantity, sanitation risk, and cost (Lloyd & Bartram 1991). The approach was piloted in Peru, and as a result of its robustness, it was later adopted by the World Health Organization (WHO) guidelines for drinking water quality (WHO 2008). In 1996, a simplified version of the five indicators was proposed by Bartram (1996). Over the years, other water services frameworks were developed by Renwick et al. (2007) and Moriarty et al. (2011). However, the recommended standards stipulated in the water services frameworks are not used in global or national monitoring systems to monitor sustainable access to improved water services (Giné-Garriga et al. 2013). Part of the reason they are not used is due to the high human and financial resources required to collect data to determine or inform the indicators (Giné-Garriga et al. 2013).

As discussed above, South Africa implemented the FBW policy as rights-based approach to guide water services provision (DWA 2003, 2017). However, water services provision is not monitored based on FBW standards, despite over two decades of implementation. This presents an information gap to inform planning, management and evidence-based strategies and policies to ensure sustainable access to improved water services.

The FBW standards can be employed as indicators to assess and monitor sustainable access to improved water services. This will result in an understanding of the level of improved water services provided and progress in the implementation of the policy. However, it is essential to understand water services provision at different administrative levels (e.g. national, provincial, district) to inform the process of identification and prioritization of vulnerable communities experiencing limited or poor access to improved water services (Giné-Garriga et al. 2013). As a result, targeted interventions can be formulated and implemented to improve water services in most at-risk communities. This can be achieved by employing a set of indicators that are; (i) easily measurable at different administrative levels, (ii) accurately defined, (iii) standardized and compatible with data collection elsewhere, (iv) scalable at different administrative levels and (v) yearly updatable (EASSY) (Jimènez Fdez de Palencia et al. 2009).

The study sought to address the existing gap concerning using FBW standards as a set of indicators to assess inequalities in sustainable access to improved water services in a rural municipality in South Africa. The indicators are considered EASSY, simplified, cost-effective, and robust. The study results are expected to demonstrate the extent to which the FBW policy is being implemented and present a snapshot of inequalities in access to improved water services in a rural municipality.

The study was conducted from November 2019 to February 2020 in four water schemes that cut across Makhudutamaga Local Municipality (MLM) in the Limpopo Province in South Africa (Figure 1). The water schemes are namely, De hoop (DH), Flag Boshielo (FB), Local Resources (LR) and Piet Gouws (PG). MLM was chosen as the study area because it is mainly rural and experiencing a high water services backlog (SDM 2020).

This study combined the Water Point Mapping (WPM) approach with a household survey as mixed-research methods to collect the research data. The WPM approach is a mapping approach that considers the geographical position of all the water sources in a particular area for mapping aspects of water services provision (WaterAid 2017). It allows for identifying communities within a particular area that are ‘served’ or ‘not being served’. The WPM approach combined with a household survey is a powerful approach to present data collected about aspects of the water services provision, supported by Giné-Garriga (2015).

In order to conduct the household survey, stratified random sampling was employed to sample statistically representative settlements and households of the entire study area. Stratified random sampling involves dividing the target population into subgroups and randomly selecting the required sample size in each subgroup (Kadilar & Cingi 2003). In this case, the population was all the settlements and households in the MLM. The subgroups (stratum) were the water schemes that cut across MLM. Table 1 provides the sample sizes of settlements and households sampled using a 95% confidence interval and a 5% margin of error. Proportional allocation of sampled settlements and households was conducted according to water schemes. Microsoft Excel was used to randomly select settlements in the different stratum equivalent to the sample size. A purposeful sampling approach was employed to sample households because no prior appointments were made; therefore, the selection of households was dependent on their availability and willingness to participate in the survey at the time of the study; supported by Palinkas et al. (2015).

The authors combined Cant et al. (2005) and Fink (2009) survey design approaches and produced a modified approach used in the survey design. The survey collected quantitative and qualitative data to inform the set of indicators comprising distance, quantity, flow rate, reliability, quality and cost derived from the FBW policy standards (Table 2). The available time the respondents had to participate in the survey was considered. As a result, the administration of the survey did not take more than 15 minutes of the respondents' time. This was considered not to have disturbed the daily routine of the respondents, especially that no prior arrangements were made with the households. The survey questions were designed to be as quick and straightforward as possible without compromising the quality and integrity of the data collected. Piloting of the survey was conducted in 20 households. Upon piloting, minor adjustments were effected to the survey instrument and finalized.

Two local enumerators were recruited and trained to assist with the administration of the household survey. The use of enumerators reduced the time and budget it could have taken to cover all the households by the researcher. It was also advantageous because it was faster since their involvement made it easy to locate most of the settlements. The settlement in which the enumerators resided was not surveyed. This was not by choice but by random selection. The surveys were administered from 9h00 in the morning to 16h00 in the afternoon. The researcher preferred to administer the survey to heads of households. However, this was not always possible because, at the time of the survey, some of them would be out (e.g. working), and if available, some of them would nominate someone in the household to represent them. For quality assurance, during the administration of the survey questionnaire, the research would conduct regular checks of the surveys completed by the enumerators. The regular checks helped to immediately address any emerging issues that may have compromised the data quality. The survey collected relevant data, as per Table 1, used for analysis to address the objectives of this study.

The data collected was captured in MS Excel. Statistical Package for Social Sciences^® (version 25) was employed to conduct descriptive statistics and cross-tabulations analyses (Field 2009). Furthermore, statistical inference (Kruskal-Wallis test) was employed to assess the difference in access to improved water services based on the FBW standards. For all the tests, the cut-off for statistical significance was set at p < 0.05, which is recommended by Field (2009).

This section presents the results of the study according to the set of indicators employed to assess geographical inequalities in sustainable access to improved water services in the study area.

There was a statistically significant difference in the return distance walked from households to collect water from IWS across the water schemes [H(3) = 61.33, p = 0.00] (Figure 2). The distance walked by households in all the water schemes complied with the FBW standard. The majority of the households (62.1%) walked a return distance of between ‘1–100 meters’ (Supplementary Material, Table S1), with 41.9% walking between ‘2–5 minutes’ to collect water from an IWS (Supplementary Material, Table S2).

There was a statistically significant difference in the quantity of water in litres/capita/day collected across the water schemes [H(3) = 72.83, p= 0.00] (Figure 3). The overall median quantity of water collected was 48.4 litres/capita/day. However, when factoring in the unreliability of improved water services using an average computed period the IWS were out of service ((10.5 days, midpoint of 2–3 weeks) (see section on Reliability)), the quantity of water collected decreased substantially by an average of 90.5% across the water schemes, ranging between 10 to 4 litres/capita/day (Figure 3). The quantity of water collected was below the recommended by the FBW policy.

Most households collected water once in a day (Supplementary Material, Table S3) and collected water once during weekdays (Supplementary Material, Table S4). The majority of the households did not collect water on weekends (74%–100%) (Supplementary Material, Table S5).

There was no statistically significant difference in the number of times IWS were out of service in the last 3 months across the water schemes [H(3) = 1.37, p= 0.712] (Figure 4). There was also no statistically significant difference across the water schemes in the average period IWS was out of service [H(3) = 6.10, p= 0.107]. The IWS were out of service for a median period of 2–3 weeks without supplying water on an average of four times in 3 months. This meant that the IWS did not supply water for a minimum of 48 days and a maximum of 72 days in 3 months. The longest median period where IWS did not supply water across the water schemes was one month [H(3) = 7.36, p= 0.061]. Therefore, the reliability of the improved water services was computed to be 53.0%, which was far below that recommended by the FBW policy.

Most of the households reported that community leaders (45.1%), community members, government, and political/ward leaders were responsible for ensuring water supply in their communities (Supplementary Material, Figure S1). The majority of the problems related to water supply were reported as follows; (i) IWS takes a long time to supply water, (ii) poor water quality, and (iii) poor alternative water sources (Supplementary Material, Figure S2). Other households (31.9%) did not comment regarding problem relating to water supply.

There was a statistically significant difference in the flow rate across the water schemes [H(3) = 20.12, p= 0.00]. The overall median flow rate was 0.14 L/s, which was below the level recommended by the FBW policy. Figure 5 shows the inequalities in flow rate of the water services across the water schemes. The majority (76.7%) of the IWS took 1–5 minutes to fill a 25 litres bottle or bucket (Supplementary Material, Table S6).

The was a statistically significant difference [H(3) = 17,29, p= 0.00] in the taste [H(3) = 17,29, p= 0.00], and odour [H(3) = 13,77, p= 0.00], and no significant difference in median scores for colour [H(3) = 6.44, p= 0.09] of water across the water schemes (Figures 6–8). There was a difference in taste of water between DH and PG, BF and PG, and LR and PG. There was a statistically significant difference in the odour of water between DH and BF, and DH and LR. Figures 6–8 shows the inequalities of water quality in terms of taste, odour and colour of water supplied by IWS across the water schemes. A descriptive analysis of the overall ‘households’ perceptions in terms of taste (61.4%), odour (84%) and colour (86%) of water indicate that the water quality was ‘good’ (Supplementary Material, Figure S3, Figure S4, and Figure S5).

Most of the households reported that the cost of buying water to supplement water collected from IWS was unaffordable (Figure 9). Supplementary Material, Figure S6 shows the percentage of households and how much they paid for water. The majority of the households paid between ZAR 300 and ZAR 1,000 to buy 300 to 5,000 litres tank of water. The water was collected from rivers, and it is not used for drinking purposes.

A majority of the households used rivers (65.7%) and boreholes (16.9%) as alternative water sources (Supplementary Material, Figure S7). Most of the households (96.5%) did not consider alternative water sources to be safe (Supplementary Material, Figure S8).

The return distance walked by households to access improved water services differed significantly across the water schemes. However, the return distance walked in all the water schemes complied with the FBW policy. Most of the households walked less than 5 minutes to access improved water services, which indicates that they used standpipes in the dwellings and communal standpipes. This is supported by SDM (2020), which report that 75% of the households use standpipes in their dwellings or communal standpipes within 200 m from the households. Majuru et al. (2012) and Coetzee et al. (2016) found similar results in studies conducted in rural municipalities of South Africa, where most of the households walked not more than 200 m to access improved water services. This was beneficial to the households because literature indicates that children living in households that accessed safe water not more than 500 m from their households were 34% less likely to get infected by water-related diseases (e.g. diarrhoea) compared to water source accessed over 500 m (Gorter et al. 1991). In addition, Majuru et al. (2012) and Bartram et al. (2014) in their studies found that households collected large quantities of water as the distance to the water source decreased. The results of this study agreed with the findings of Majuru et al. (2012) and Bartram et al. (2014).

Households collected quantities of water above 25 liters/capita/day in compliance with the recommendation of the FBW policy. However, there were inequalities in the quantities of water collected across the water schemes. Key to households collecting water above the recommended FBW standard is that they collected water to store in different container sizes for later use as a measure to cope with the unreliability of the improved water services. This explains why most households collected water once to thrice in a day when improved water services were operational to fill containers. Therefore, the quantities of water collected were dependent on the water storage capacity of the households and the reliability of improved water services. The practice of water storage posed a potential health risk to the households, as a study conducted by Majuru et al. (2011) and Majuru et al. (2012) found that water collected from IWS and stored in containers was contaminated and of unacceptable drinking quality due to improper storage. This, as a result, deprives households of the health benefit of having IWS within the recommended distance of 200 m. When the unreliability of water services was factored in, the quantities of water collected in liters/capita/day substantially reduced; as a result in such cases, improved water services did not comply with the FBW policy.

As indicated above, the improved water services did not comply with the FBW standard of reliability. This is because households would go for a long time (48 to 72 days in 3 months) without accessing water from the IWS. The unreliability of the improved water services was a common challenge in all the water schemes. It explains why when asked, ‘what are the challenges regarding water services provided?’ most households indicated that ‘it takes long to get water’. The findings are supported by studies conducted in rural communities which found that improved water services go for a long time without supplying water (Majuru et al. 2012; Sambo et al. 2018). The unreliability of IWS in the study area supports the statement made in the IDP report that water supply in the study area remains a significant challenge (SDM 2020). It can be attributed to low rainfall (as water-scarce district) and inadequate protection of water resources on the supply side, and increasing demand as a function of population growth as well as inadequate operation and maintenance (O&M) of critical water infrastructure (Sambo et al. 2018; SDM 2020). Despite the challenges with water supply, most households indicated that community leaders, community members, and government are responsible for ensuring that there is water supply in their communities. This indicated that communities are not only reliant on the government to address their water situation but have a sense of responsibility and ownership towards the water infrastructure in their communities. This can explain why households connected pipes to the main underground pipes to connect standpipes in their dwellings without the authorization of the WSP, as observed in this research and also reported by SDM (2020).

The additional connections to the main water pipes were expected to reduce the flow rate of water discharged from stand pipes. However, the flow rate was not significantly affected as it was slightly below the recommended FBW standard. The connections to the main pipes, increase in population, and unreliability can substantially reduce the water discharge flow rate. This is because it can result in higher than average households collecting water simultaneously with most taps open. It is a potential challenge that needs to be closely monitored and addressed when it emerges.

The perceptions of the households regarding water quality in terms of organoleptic properties of taste, odour, and colour were used to assess the water quality. Most of the households perceived the taste, odour and colour of the water supplied by improved water services to be ‘good’. When asked, households were not aware of any water quality issues arising from using improved water services that resulted in an outbreak of any waterborne diseases or mortality. The results concur with those of a study conducted in the rural municipalities of South Africa that found that most participants perceived water to be ‘good’ based on organoleptic properties as a measure of water quality (Coetzee et al. 2016). This is contradictory to the findings of a study conducted by Steelman et al. (2015), which found that more than half the respondents perceived water not to be safe. What is interesting in the study is that the perceptions of water quality were substantiated by the biophysical data collected (Steelman et al. 2015). This may be the case for our study, however, we did not triangulate perception and biophysical water quality data to support this.

However, because of the unreliability of the IWS, households were forced to either use unimproved water sources or purchase water (Hunter et al. 2009; Majuru et al. 2011). Households reported that the cost was ‘just too much’ for them as most of the people in the households were unemployed, therefore relied on old-age pension grants and child support grants to sustain the households, supported by SDM (2020). Literature indicates that households sacrificed their budget for food to purchase water in most cases, which in turn can contribute to under-nutrition (Cairncross & Kinnear 1992). However, it was a different case for those who could not afford to sacrifice because of an already heavily constrained budget. Those that could not afford resorted to collect water from the river and other water sources, in which a majority have indicated that the water is unsafe. This agrees with the literature that rural households are forced to use unimproved water sources due to the unaffordable cost of water (Giné-Garriga et al. 2015; Sambo et al. 2018). This, as a result, poses a severe health risk to the households. This is why the cost of water should not prevent people from accessing sufficient, reliable, and safe water for their basic use, as it has a human right implication (Martinez-Santos 2017).

We conclude that aspects of the improved water services provided in the study area did not comply with the standards stipulated in the FBW policy. Overall, there were inequalities in access to improved water services based on FBW standards. Aspects of distance, quantity, flowrate and quality complied with the FBW standards. However, when unreliability of the improved water services was factored according to the average period IWS were not operational, quantity of water collected did not comply with FBW standard. Households collected high volumes of water for storage for later use as a coping measure with the unreliability of improved water services. The unreliability of IWS is concern as when IWS were not operational and stored water had runout, households were compelled to buy water or resort to unsafe water sources, which posed a threat to their health. With most households not able to afford the cost of buying water, it meant that they resorted to unsafe water sources. This directly infringes on the right of households to access sufficient and safe water and their right to life. Therefore, there is a need to properly implement the FBW policy by addressing issues of unreliability, which can result in sustainable access to improved water services.

We recommend incorporating the FBW standards as indicators in the current municipal monitoring system to track inequalities in sustainable access to improved water services and implementation of FBW policy. The expectation is that the information derived from monitoring can be used by water managers to inform planning, management, and evidence-based policies and strategies to ensure sustainable access to improved water sources in rural municipalities. This will contribute to achieving universal access to water, which is a human right.

We would like to acknowledge the University of Venda (UNIVEN), Department of Higher Education and Training – South Africa (DHET) and National Research Fund – South Africa (NRF) for providing the funding for this study as part of a PhD study.

Due to budget and time constraints, the study's limitation is that this study did not conduct an in-depth investigation of the social, economic and environmental dimensions to contextualize why households in the different water schemes were experiencing water services below the recommended FBW standards. This can be explored in future research studies.

The authors declare no conflict of interest.

Ethical clearance for the research was granted by the University of Kwa-Zulu Natal (UKZN) ethics committee (Protocol reference number: HSS/0863/018D).

All relevant data are included in the paper or its Supplementary Information.