Small piped water supply systems are often unable to provide reliable, microbiologically safe, and sustainable service over time, and this has direct impacts on public health. Circuit Rider (CR) post-construction support (PCS) addresses this through the provision of technical, financial, and operational assistance to these systems. CRPCS operates in low and high-income countries; yet, no rigorous studies of CRPCS exist. We measured the impact of CRPCS on ‘water quality’ and ‘sustainability’ indicators (technical and administrative capacity, and water supply protection) in El Salvador. In this field-based study, a case-control design was utilized in 60 randomly selected case (28 CR) and comparable control (32 noCR) communities. Microbiological water quality tests and pre-tested structured key-informant interviews were conducted. The operational costs of CRPCS were also assessed. Data were compared using parametric and non-parametric statistical methods. We found communities with CRPCS had significantly lower microbiological water contamination, better disinfection rates, higher water fee payment rates, greater transparency (measured by auditable banking records), greater rates of household metering, and higher spending for repairs and water treatment than comparable control communities. CRPCS is also a low-cost (<$1 per household/year in El Salvador) drinking water intervention.

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