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dc.rights.licenseCreative Commons Attribution 4.0 Unported (CC BY 4.0) license
dc.contributor.authorHove, Jenniferen
dc.contributor.authorD'Ambruoso, Luciaen
dc.contributor.authorMabetha, Dennyen
dc.contributor.authorvan der Merwe, Mariaen
dc.contributor.authorByass, Peteren
dc.contributor.authorKahn, Kathleenen
dc.contributor.authorKhosa, Sontoen
dc.contributor.authorWitter, Sophieen
dc.contributor.authorTwine, Rhianen
dc.identifier.citationHove, J., D’Ambruoso, L., Mabetha, D., Van Der Merwe, M., Byass, P., Kahn, K., Khosa, S., Witter, S. and Twine, R. (2019) ‘“Water is life”: developing community participation for clean water in rural South Africa’, BMJ Global Health, 4(3), p. e001377. Available at:
dc.descriptionSophie Witter - ORCID 0000-0002-7656-6188
dc.descriptionItem previously deposited in University of Aberdeen repository on 18 June 2019 at:
dc.description.abstractBackground South Africa is a semiarid country where 5 million people, mainly in rural areas, lack access to water. Despite legislative and policy commitments to the right to water, cooperative governance and public participation, many authorities lack the means to engage with and respond to community needs. The objectives were to develop local knowledge on health priorities in a rural province as part of a programme developing community evidence for policy and planning. Methods We engaged 24 participants across three villages in the Agincourt Health and Socio-Demographic Surveillance System and codesigned the study. This paper reports on lack of clean, safe water, which was nominated in one village (n=8 participants) and in which women of reproductive age were nominated as a group whose voices are excluded from attention to the issue. On this basis, additional participants were recruited (n=8). We then held a series of consensus-building workshops to develop accounts of the problem and actions to address it using Photovoice to document lived realities. Thematic analysis of narrative and visual data was performed. Results Repeated and prolonged periods when piped water is unavailable were reported, as was unreliable infrastructure, inadequate service delivery, empty reservoirs and poor supply exacerbated by droughts. Interconnected social, behavioural and health impacts were documented combined with lack of understanding, cooperation and trust between communities and authorities. There was unanimity among participants for taps in houses as an overarching goal and strategies to build an evidence base for planning and advocacy were developed. Conclusion In this setting, there is willingness among community stakeholders to improve water security and there are existing community assemblies to support this. Health and Socio-Demographic Surveillance Systems provide important opportunities to routinely connect communities to resource management and service delivery. Developing learning platforms with government and non-government organisations may offer a means to enable more effective public participation in decentralised water governance.en
dc.description.sponsorshipThis study was funded by the Joint Health Systems Research Initiative from Department for International Development/MRC/Welcome Trust/Economic and Social Research Council (MR/N005597/1 and MR/P014844/1). This work was nested within the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), supported by the University of the Witwatersrand and Medical Research Council, South Africa.en
dc.relation.ispartofBMJ Global Healthen
dc.rights© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY.
dc.title‘Water is life’: developing community participation for clean water in rural South Africaen
rioxxterms.typeJournal Article/Reviewen
qmu.authorWitter, Sophieen
qmu.centreInstitute for Global Health and Developmenten

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