2.5 Challenges Presented by Limited Access to Safely Managed Water in Rural Contexts
2.5.1 Water, Health and Wellbeing
Limited access to safe drinking water, quality sanitation facilities, unhealthy hygiene practices, and improper water management practices can promote water-borne diseases (Emenike et al., 2017). Rural communities face many significant health challenges, such as diarrhoea, and cholera that rural communities (i.e., households and individuals) when they have limited or no access to safely managed water sources and/or are cut out from accessing water services. A recurring theme across studies is the prospect and burden of disease among rural communities because of their marginalisation from essential water services. The most significant challenges to world health have been the prevention of water-related diseases such as the Guinea-worm disease23 (also known as Dracunculiasis), cholera, typhoid, malaria, hepatitis A and diarrhoea (Tumwine et al., 2002; Mills & Cummin, 2016). The WHO Drinking-Water Fact Sheet, released on 14 June 2019, states that 2.2 billion people in rural communities are without access to safe water sources and use drinking water contaminated with faecal matter. Illnesses from drinking contaminated water are estimated to cause 485 000 deaths each year (WHO, 2019b).
These water-related diseases, while preventable, are often prevalent in remote rural communities where there is no reliable municipal water service delivery and communities rely on often stagnant, largely contaminated water sourced from low streams, ponds, lakes, and
23 Guinea-worm disease is a parasitic infection by the Guinea worm. People become infected when they drink unpurified water that contains water fleas with guinea worm larvae. For more on the Guinea-worm disease, see work by the Centers for Disease Control and Prevention (Grigg, 2019).
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others (Dankwa, Fuseini & Dankwah, 2018; Lewis, n. d). For example, annually, over 400 000 people die of diarrhoeal-related illnesses due to drinking contaminated water from unsafe sources (WHO, 2019b). Within this context, scholars argue that limited access to safely managed water supply further diminishes people's dignity, compromises their health, and violates their rights (Armah et al., 2018; Neves-Silva, Martins & Heller, 2018).
Adequate and safe water and sanitation services are essential not only to reduce the enormous burden of diseases such as diarrhoea, respiratory infections, and malnutrition but also for the control and elimination of many neglected tropical diseases. The WHO (2019a) & WHO (2019b) report that 54–65 percent of all deaths due to diarrhoea in low- and middle-income countries are attributable to unsafe drinking water, lack of proper sanitation, and hygiene. A further 829 000 deaths annually are caused by water-borne illnesses. Further, corresponding findings from Prüss-Ustün et al. (2019) show that from the 1.4 million diarrhoeal recorded cases in 2016, over 400 000 led to deaths. Likewise, a similar finding is reported by scholars in the rural areas of Nigeria, where water insecurity drives individuals to use contaminated water sources that spread disease and increase mortality rates (Peter & Umar, 2018). Another prevalent water-related disease reported in the literature is Trachoma (Garn et al., 2018;
Gebretnsae et al., 2020; Phiri et al., 2018). This is a chronic and contagious eye disease that causes blindness (Gupta et al., 2017; Oswald et al., 2017; WoldeKidan et al., 2019). Trachoma is a significant public health problem in resource-poor rural communities. Worldwide, 190 million people in 41 countries live in areas endemic for trachoma (WHO, 2019c). The disease is caused by poor access to domestic water supplies and limited access to and use of safe latrines or toilets.
Health problems related to a lack of access to safe water sources affect the socio-economic wellbeing of individuals, households, and communities (Howard et al., 2020; Nadeem et al., 2020; Zhou, Deng & Wu, 2017). According to the WHO (2017b), loss of productivity to water and sanitation-related diseases costs many countries up to 5 percent of their GDP. Health costs associated with water-borne diseases represent more than one-third of poor households' income in Southern Africa (Bradshaw & Steyn, 2001; Hariharan, 2019; WHO Regional Office for Africa, 2019; Odwori, 2020). Furthermore, in global south countries, and in instances where individuals seek healthcare services to treat water-related diseases. Literature reports a 22 percent increase in opportunistic infections and fatalities in rural healthcare facilities (such as clinics) because these facilities do not have reliable and life-saving water needed by patients
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(WHO, 2019c). The WHO (2019c) reports that over 21 percent of healthcare facilities in global south countries do not even have access to sanitation services.
Literature also points to psychosocial24 and mental health-related challenges where water is scarce and in cases where municipalities do not deliver. For example, Workman and Ureksoy's (2017) research measured the psycho-emotional and psychosocial effects of food and water insecurity, also emphasizing that water insecurity was associated with increased anxiety and depression. Psychosocial and pyscho-emotional effects were linked to households being forced to live in unclean conditions and having to use water sparingly (Workman & Ureksoy, 2017).
Aihara et al. (2015) conducted a quantitative study investigating the effects of a household's water insecurity scale on psychological distress in Nepal and noted that the participants found it stressful to perform household duties. Moreover, the participants reported a loss of opportunity for social interactions resulting from walking long distances to fetch water. Bisung and Elliot (2016) argue that mental health challenges arise from the persistent stressful experiences about water collection and use. The psychosocial health impacts related to water are more than feelings of physical fatigue or inability to carry water. Instead, frustration and stress are also associated with the burden of collecting water, negotiating access to water at both the household and community levels, the cost of purchasing water from vendors, and not having enough water available to use daily (Bisung & Elliot, 2016; Brewis et al., 2019). Several other scholars suggest that limited access to safely managed water causes anger, worry, anxiety, and increased conflict in both households and communities (Stevenson et al., 2012; Stevenson et al., 2016; Wutich & Ragsdale, 2008; Wutich, 2009). What is further disconcerting are reports of physical and sexual assaults during trips to fetch water from sources that are a distance from households (Stevenson et al., 2016). According to Stevenson et al. (2016), the possibility of sexual or physical assault causes fear, panic, and a daily sense of anxiety among those responsible for collecting water. If water access continues to be a recurring challenge, health will inevitably continue to be affected.
24 Psychosocial health refers to individual's perceptions of- and response to social and environmental conditions
and status and how they react to their current and anticipated living conditions (Bisung & Elliot, 2016).
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