Department Sanitation, Water and Solid Waste for Development
Participatory Action for Long-Term Arsenic-Safe Water (PACT)
PACT in brief. This health related behaviour change research focuses on the prevention of arsenicosis and prevention of diseases caused by microbial contamination of drinking and cooking water in Bihar, India. Many safe water mitigation options exist, but most of the community based infrastructure is functional and not used. Combined, intervention on psychological ownership and habitual behaviour can lead to a long-lasting functionality and sustainable use of the safe water infrastructure. The effectiveness and the way how these concepts change peoples behaviour through psycho-social factors are subject to this research. The project takes place in Arsenic-affected areas of Bihar.
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Background
Drinking and cooking water can be unsafe due to natural (e.g. geogenic Arsenic in groundwater) or anthropogenic contamination (e.g. microbiological pollution) and puts people at risk of adverse health related consequences.
Arsenic. Arsenic-contaminated water is consumed by app. 100 million people worldwide, including Bihar (India) where this project takes place. Arsenic has severe, but delayed health consequences: it is an invisible and taste- & odorless poison in water and food, that not only affects health in the long-term (e.g. cancer), but as well in the short term: e.g. skin-related diseases. It affects health severely and people suffering from Arsenicosis are often psycho-socially marginalized (e.g. stigmatization; Sen & Biswas, 2012), due to their visible symptoms. But nevertheless, arsenic is not necessarily well known in the population of areas with affected groundwater.
For more information on arsenic contamination, please refer to the WHO fact-sheet.
Geogenic contamination of groundwater
In some groundwaters, arsenic and fluoride can naturally reach concentrations that are hazardous to human health if geological and geochemical conditions favour the release of these contaminants. More information can be found on the groundwater quality information management system on geogenic contaminants (GAP) of Eawag.
Microbiological contamination. Basic hygiene-related diseases have a significant impact on human health. For example, WHO estimates that diarrhoea causes approximately 2.2 million of the 3.4 million water-related deaths per year. Microbiological contamination of drinking & cooking water has immediate health consequences. Most often, water-related disease are infectiouos (such as diarrhoea or other enteric disease). A majority of the trajectories will prone only mild outcomes. However, a proportion or because of recurring mild cases, people will suffer of more severe outcomes. Several waterborne pathogens, such as Vibrio cholera or some stems of Escherichia coli, can even cause fatal trajectories.
For more information on microbiological contamination, please refer to the WHO fact-sheet 1 or WHO fact-sheet 2.
SDG 6 - NRDWP & Jal Jeewan Mission. With SDG 6 - Sustainable Development Goal 6 – the UN aims to “ensure availability and sustainable management of water and sanitation for all”. This goes hand in hand with some of the initiatives of the Indian central government: The national health plan by the central government of India covers as well the aspect of drinking water with the national rural drinking water programme (NRDWP), the government intends to provide every person living in rural areas with safe water […] on a sustainable basis”.
SDG 6
6.1 By 2030, achieve universal and equitable access to safe and affordable drinking water for all.
6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials (…) .
NRDWP & Jal Jeewan Mission
The National Rural Drinking Water Programme (NRDWP) is aimed at providing every person in rural India with adequate safe water for drinking, cooking and other domestic basic needs on a sustainable basis. Safe water is to be readily and conveniently accessible at all times and in all situations and therefore, the scheme focuses on the creation of the infrastructure.
Under the NRDWP the Central Government of India has established the Jal Jeevan Mission to provide safe water through piped water supply to every household in India by 2024. It is a community based approach on improving or construct newly infrastructure to provide tap water connection to every rural household.
Goals
Theory-based and evidence-based behaviour change interventions can successfully promote the immediate adoption of safe water infrastructure (up to 40% greater adoption than controls) by the public, as shown in a previous study in Bangladesh.Less is known, however, about behaviour change in the long term. Thus, this project investigates two key concepts to facilitate long-term adoption of mitigation options: psychological ownership (this is my mitigation option or this is our mitigation option) and habitual use (to associate water-collection consistently with arsenic-safe schemes) in a Cluster-Randomized Control Trial (C-RCT) in Bihar (India). We preregistered the C-RCT on OSF.
Methods
After a formative research phase, using mixed-methods a 2x2 cluster-randomized factorial trial will be conducted to test the effects of ownership- and habit-promoting interventions.
Outcomes
The effectiveness of the interventions will be determined by comparison of groups at midline and endline surveys. The main outcome at the cluster-level is functionality of the water-schemes and the main outcome at the individual level is the collection of arsenic-safe drinking water. Secondary outcomse are, psychological ownersip and self-reported habit strength to collect arsenic-safe water. Furthermore, we will assess context variables and the psychosocial mechanisms of the intervention using questionnaires.
Current status of PACT
In a participatory and iterative process, we developed community-based interventions and performed household interventions, how psychological ownership and habitual water collection can be fostered best in the local context. To date, 3148 water samples were analyzed and 2265 interviews were conducted. The results are continuosly disseminated at international conferences, and lectures or workshops in India. The most important finding so far is:
Psychological ownership is understood in the local context of rural Bihar and safe water supply infrastructure. Psychological ownership can therefore be measured and is associated with certain routes (antecedents) and certain consequences:
Currently, we are implementing the interventions in the 64 habitations. Since Sars-Covid-19 outbreak started, we integrated a preventive low-level intervention also on this specific disease. After completing the interventions in November 2020, we will conduct a midline survey to assess the effects of the interventions. Before monsoon 2021, we will conduct an endline survey to assess long-term effects of the interventions.