A primary water gatherer, or happy mother, with her children during the day. Photo: Tara Rava Zolnikov
Global public health interventions focus on providing solutions to unaddressed humanitarian issues in developing countries; priority projects include providing communities with access to water, food, healthcare, and more. The expanse volume and variety of interventions generates difficulty in assessing and evaluating the success of projects. There is a strong need for evidence-based research tools to evaluate the impact of interventions. While interventions continue to be classically difficult and primarily subjective in determining overall success or failure, understanding the outcome remains a critical aspect of public health interventions.
Providing nearby access to safe drinking water is a primary public health concern and a frequent public health intervention. According to the World Health Organization’s Millenium Development Goals, approximately 1.1 billion people continue to lack access to clean water. In 2001, approximately four million people died worldwide from waterborne disease. This outstanding issue was first internationally addressed in 1977 at the Mar De Plata Conference. Since then, numerous water intervention programs have been established throughout the world. In fact, the World Health Organization reports from 1990 to 2002, access to safe drinking water throughout the world rose from 77 to 83 percent and affected approximately 1 billion people.
"We had few times to sit together as a family... because she was always away collecting water"
Eliminating adverse health effects is the primary reason for implementing water interventions; current improvements in water quality supply focus on minimizing health impacts, including environmental contaminant exposures and water-borne diseases; however, additional outcomes may arise from implemented water interventions; social effects are one outcome of water interventions that have not been reviewed. Relationship development may play a significant role in intervention acceptance. Both health and social outcomes may contribute to the success or failure of water interventions.
An example of an implemented water intervention, a kiosk, stationed in a remote village in Kenya. Photo: Tara Rava Zolnikov
Previous research has focused solely on health effect outcomes and has not reviewed the impact of social effects in implemented water intervention. The purpose of this study was to explore changes in relationships and time between family, friends, and community members after experiencing an implemented water intervention in the community. These personal experiences provided a greater understanding of familial and community relationships experienced by family members after receiving access to nearby, safe water and these relationships may provide insight to future water intervention success.
The research setting occurred in a historically semi-arid region in Kenya, where community members have been beneficiaries of various water interventions. In this region and throughout Kenya, primary water gatherers are primarily the female head of household, but occasionally include a child or adolescent girl. Prior to the water intervention and depending on their socioeconomic status, primary water gatherers could walk up to 7 hours a day carrying 20 liters of water on their back while herding their livestock 10 km to Athi or Tiva River. One mother explained when being asked if she liked the water intervention, “I like that water. And, I even lack words to explain… because as I said, previously I used to go to Athi River for four hours and come back with 25 liters of water. Imagine 25 liters of water with a family of 10 people. This… you wouldn’t have water to bath, to clean the clothes, it was only for cooking and drinking. So, I can’t fail to love and like this water. And everybody in this community is like me because we were all facing the same thing.”
The primary water gatherer would collect water every other day, spend hours away from the household and in some cases, children would miss school, and then return with enough water for basic household use. One mother confessed, “We used to skip bathing- even at times, we might not cook because we lacked water to cook the food. The food was there, but no water to cook it.” Gathering water could be physically tiring and even dangerous. “We went as a group, at 4 am, and at noon we would be back, but be very tired. It is quite far. Going took about four hours, the process of collecting, then coming back… And coming back was the hardest because you were climbing- it was very hard,” said one water gatherer. “We used to leave at midnight and arrive in the morning. We had to go as a group because we were scared of the cries from hyenas…because I was going in at the dark hours, there was the danger of falling into the river…. And hippopotamus were there. The women were very scared,” exclaimed another water gatherer.
This situation created a substantial strain on relations in the family. Family members experienced difficulties in irregular meal times and food availability, inability to converse with the mother on household or school-related issues, irritation with lack of bathing and cleanliness, and general discontent with not having the helping hand of one able-bodied family member available. One child exclaimed, “We had few times to sit together as a family- to sit with our mom- and talk and explain to her what we were taught in school or what we were required to do in school. Because she was always away collecting water…. When she came home, she had other things to do.”
Primary water gatherers in Kenya at a nearby river loading water into 20 liter jerrycans. Photo: Tara Rava Zolnikov
After receiving nearby access to quality water- a 1 hour roundtrip venture- participants experienced significantly improved relationships. One mother explained, “There is a big difference in our relationship which has started with the water in the compound because now I never leave my children and also am able to take care of the older father.” Family relationships improved as a result of improved access to water and less fighting over meager resources. “If you want to bathe, no problem…. If you want to wash the clothes, no problem- because the water is there or can be gotten easily. That helps us in our relationships with each other- and making each other feel bad because we want to do one of those things,” said another primary water gatherer mother.
"We used to skip bathing- even at times, we might not cook because we lacked water to cook the food."
Relationship differences occurred differently based on the role in the household of the primary water gatherer (e.g. mother or children). If the primary water gatherer was the mother, the additional time was used on conversations with her spouse to discuss plans on building the farm, new housing structures or economic undertakings, while time with her children was primarily used to discuss school-related news or achievements, homework, or fees. “Our relationship is more strong in the family since the inception of this project… just come and find me with my grandchildren and my husband. We will be laughing, very happy- it shows we are closer together as a family. And that was not the case when I was getting water for Athi. I usually used to ask myself, when will this end? Can we even migrate to go to another place? But now, I’m comfortable and my family is happy. Nobody complains about water, who misused the water, who did this… previously, we had that. If I found the water has been used up, I get angry and would say, ‘who misused this water!’- because I was the one to go and gather again. Even my grandchildren here- there are so happy about the water- they will insist on accompanying me to get the water. I have made small jerrycans for them to carry when they go with me… they come and we are all very happy!” exclaimed one grandma, also a primary water gatherer. Water provided children with opportunities to attend school instead of gathering water. One mother confessed, “Even I can say, my kids are schooling better. There are no problems looking for water. We don’t’ have any of our kids missing school because they are going to collect water.” If the child or adolescent was the primary water gatherer, relationships were improved not only within their family unit, but with their head schoolteacher and friends as well.
Community member’s experiences after implemented water interventions reveal enhanced relationships within household family units. Additional personal time was gained through implemented water interventions and was used to re-build relationships. The newly established relationships encouraged growth through family discussions and conversations understanding and providing solutions to economic or individual challenges.
This supplemental information provides a critical component to consider during the development phases of global public health water interventions and may have a significant role in the acceptance; additionally, this research provides evidence of an increased need for access to quality water for communities throughout the world in order to positively contribute to constructive family relationships. There is a continual need to provide communities with access to water in order to provide the health benefits of water to communities as well as encouraging and promoting family relations.