Designing institutions and health education interventions for sustainable supply of safe water in urban informal settlements: the case of Kenya

Diarrheal diseases caused by poor water, sanitation and hygiene continue to kill more children in Sub-Saharan Africa's burgeoning informal urban settlements than in any other part of the world. In recent years, Delegated Management Model (DMM), a partnership in which a utility delegates service management to slum residents have been promoted as new models to improve services.

This dissertation examines the benefits of DMM by comparing water services in three informal settlements in Kisumu city, Kenya: two slums where DMM has been implemented, and one, a control, where it has not. In addition, the research examined how school-based hygiene interventions could be designed to improve safe water and hygiene knowledge in urban informal settlements. This study compared outcomes of two approaches to hygiene education, one which combined messages with participatory water testing; the second used hygiene messages alone.

Results of the DMM study showed that DMM implementation had lowered water cost and improved provider accountability. However, unhygienic water collection and handling practices on the part of the service users could contaminate drinking water that was clean at the delivery point, thus preventing the intended health outcomes of DMM from being realized. Results of the hygiene education intervention showed that one week after the inventions, hygiene knowledge among students who received the intervention that combined hygiene messages with participatory water testing was significantly improved. Evaluation of the intervention 12 months after implementation showed that the hygiene knowledge gained was sustained.

The research findings suggest that: i) regular monitoring of water quality at the kiosks is essential to ensure that the DMM model achieves intended health outcomes, ii) sanitation conditions at kiosk sites need to be regulated to meet minimum hygiene standards, and iii) customers need to be educated on safe water collection and storage practices. Finally, school-based hygiene education could be made more effective by including hands-on water testing by students. Making sustainable impact on health and wellbeing of slum residents requires not only building effective partnerships for water delivery, but also paying close attention to the other points of intervention within the water system.