Long-Term Community Engagement and Participatory Education for Improving Water and Health Outcomes: A Case Study in Rural Tanzania

Progress toward Sustainable Development Goal 6.1, universal safe drinking water access, has been slow, raising important questions regarding the present methodological paradigm (UN, in Sustainable Development Goals Report, United Nations, Geneva, 2021). For instance, Martin et al. (Tropical Med Int Health 23:122–135, 2018) found 65–95% of drinking water interventions in rural areas failed to realize their intended results within 6 months of implementation, contributing to systemic marginalization of populations in these geographies. Reform of sectoral practices in engaging communities and promoting sustainable water, sanitation, and hygiene (WaSH) is therefore in order. This research responsively investigates localized and participatory intervention planning and education methods, combined with regular interfacing between implementers and participants, as a mechanism for improving long-term water-related health. Multi-year consultations in rural Tanzania combined key informant interviews, focus groups, and observational learning to develop a 14-week (3-month) participatory WaSH education program among Maasai women. Ceramic water filters were provided for home-use and diarrheal outcomes among the participants, and their children were recorded regularly over an 18-month evaluation period. Educational lessons were also thrice repeated at baseline, 9 months, and 15 months. Initially, the percentage of the group reporting monthly diarrhea decreased from 38% at baseline to 8% at the 3-month mark, increasing to 32% at the 6-month reporting time after educational lessons were paused. After education restarted at 9 months, 0% reported diarrhea at the 12-month mark. Reported diarrhea then increased to 5% after a second pause in programming at 15 months, decreasing to 3% at 18 months after the third set of educational lessons. Additionally, less filters broke during this program than was reported in literature (Brown in Ceramic Filters for Point of Use Drinking Water Treatment in Rural Cambodia: Independent Appraisal of Interventions from 2002–2005, 2007). The intervention therefore showed a positive correlation between education provision, health, and filter care illustrating how locally relevant education may facilitate water technology uptake, and that regular interfacing between implementers and participants is critical to addressing long-term water access.