Providing safe water to the poor in developing countries is a challenge that has
persisted through decades of international development efforts, from the International
Decade for Clean Drinking Water through the years of the Millennium Development
Goals and now into the new age of the Sustainable Development Goals. The often-stated
long-term goal of the water, sanitation and hygiene sector is to provide piped, treated
water as a solution to this challenge. In the meantime, household water treatment and safe
storage (HWTS) has been put forth as an interim solution that could be quickly scaled up.
Critically, effectively scaling up HWTS requires achieving both coverage and uptake,
meaning that HWTS must not only be made available to but also be used correctly and
consistently by the target population in order to achieve improved health. This
dissertation explores HWTS as an interim solution and the arguments for scaling-up
HWTS to meet the immediate needs of populations currently without safe water. To do
so, it considers HWTS from three different angles: as a concept in the literature, as
products being sold and implemented, and as a national-level policy.
Chapter 2 reviews the literature on HWTS, identifying three key types of
literature and the means by which HWTS has been evaluated over the past two decades.
An impact evaluation of three influential publications highlights the prominence of both
scientific and grey literature and the influence that they – and their authors – have on
actors in the HWTS sector. Chapters 3 and 4 focus on the critical case of Ghana, a
country that has made significant progress in increasing access to safe water but still
suffers from a disparity among urban and rural, rich and poor within this improved
access. Ghana has been the recipient of ongoing support (financial and otherwise) from
iii
the World Health Organization (WHO) and the United Nations Children’s Fund for the
scale-up of HWTS in country, both with respect to implementing HWTS and developing
HWTS-specific policy.
Chapter 3 investigates efforts to disseminate three HWTS products in Ghana, with
an emphasis on both reaching vulnerable populations and on achieving scale through
commercialization. The challenges and successes of these efforts highlight conflicts of
interest with respect to reaching those most in need and achieving commercialization.
Chapter 4 considers HWTS as a policy through an evaluation of Ghana’s 2014 National
Strategy for HWTS and its supporting documents. Tying in the experiences from the
previous chapter and the current status of regulation in Ghana, this chapter explores the
content of Ghana’s HWTS policy and whether it effectively supports the scale-up of
HWTS. Chapter 4 also takes into account the international context in which Ghana’s
policy exists and specifically considers the WHO International Scheme to Evaluate
Household Water Treatment Technologies as a support tool for Ghana and whether it,
too, effectively supports scale-up.
Throughout all three chapters, the arguments for HWTS as an interim solution
that can rapidly reach scale create a common thread. Within this thread, a common
assumption among proponents of scaling-up HWTS is that market strategies will
facilitate this process. As highlighted in Chapter 3, however, the goals of providing safe
water to vulnerable populations and achieving scale-up through commercialization often
come in conflict, especially when considering the need to achieve coverage and uptake to
improve health. The case studies, policy development and roll out in Ghana point to a
need for continued, long-term commitment from the government, donors and NGOs if
iv
HWTS is to be scaled up. If this is the case, HWTS is likely not an interim solution but a
long term one. The conversation must shift to recognize this reality.