Use of the Household Water Insecurity Experiences (HWISE) scale to evaluate rural water delivery in small Ecuadorian communities

Community-led water systems are an important strategy to provide reliable,
clean piped water to small, rural, and dispersed communities. However,
evaluating the effect of these systems on small communities is
challenging. To complement the  WHO/UNICEF Joint Monitoring
Programme (JMP) water service ladder, the Household Water Insecurity
Experiences (HWISE) Scale, an experiential measure of water availability,
accessibility, use, acceptability, and reliability that has been linked to
multiple health and social outcomes, may support an improved understanding
of how improvements in water access affect communities. In 2023, Green
Empowerment, an organization that supports the development of
community-managed water systems in Ecuador, and local partner
organizations, integrated the HWISE Scale, using a 4-week recall period,
into routine monitoring and evaluation surveys for communities where a new
piped water system, or an upgrade to an existing piped water system, was
planned. Baseline data were collected from 19 Ecuadorian communities in
three regions (coastal, highland, and Amazon) and in three languages
(Spanish, Kichwa, and Cha’palaa). This included communities with no piped
water and communities with water systems with varying levels of service
quality. Endline (post-intervention) evaluations were completed in 4 of
these communities. We also collected baseline and endline data from 1
Colombian community where an non-perceivable infrastructure modification
in the water system was implemented. We used logistic regression to
evaluate risk factors for reported water insecurity at baseline and
unpaired two-sided t-tests to evaluate differences in reported water
insecurity pre- versus post-intervention. We found that communities with
unreliable piped water often reported considerable water insecurity
between households, with mean HWISE scores similar to those of communities
fully reliant on surface or rainwater. Reported water insecurity was
reduced by 1.6-3.3 points on the HWISE-4 Scale post-intervention in 4
communities with a tangible system improvement, and by 0.8 points in the
community with the non-perceivable intervention. The HWISE Scale enriched
traditional water service/access indicators and was sensitive to changes
in households’ experiences of water or attitudes towards their water
infrastructure.