2004 Bridges Summer Research Report Anita Milman Energy Resources Group "The Efficacy of Community Managed Water Systems in Rural Mexico"

The goal of my trip to Guerrero, Mexico was conduct preliminary field research on the role of community managed potable water systems in influencing the health and development of the community. My long-term objective is to arrive at an understanding of what social, cultural and political factors make some of these water systems more effective than others. The information I collected over the summer will be used as a stepping stone upon which I base much of my doctoral research. My research is part of a larger project which also aims to quantify the effectiveness of those water systems in reducing the incidence of childhood diarrheal disease and conduct a cost-benefit analysis of the impact of these water systems.

This summer, I spent two months in Guerrero Mexico together with another graduate student whose work also contributes to the larger study. During this time, I was involved in a variety of activities which can mostly be divided into three categories: collection and verification of data, site visits, and interviews with government officials.

Data Collection and Verification

The process of collecting and verifying data began immediately upon my arrival in Mexico. The first two weeks of my visit I spent in Cuernavaca working together with Dr. Jorge Salmeron of the Instituto Mexicano de Seguridad Social, who has been collecting data on the incidence of gastro-intestinal illness for our 100 study sites. This data, which is subdivided by age group and diagnostic code, has been collected on a weekly basis by the majority of health clinics in Guerrero from 1998 to the present. I checked to see which data had already been collected and entered into a database as well as which data was missing. If data was missing, I tried to determine the reason for its absence (no doctor, new or defunct health clinic, misclassification or other.)

Focus group on water source choice and use practices, La Barra, Coyuca de Benitez.

Our list of 100 study sites includes 60 villages which contain community based ultraviolet light water filters (UVW) and 40 which do not. Those communities which do not have water filters were included to serve as control villages to represent the base case of the incidence of disease which would occur were there no water purification in the village. I investigated the appropriateness of the control groups we had selected. I located Mexico INEGI year 2000 census data and GIS maps to compared our village location and population data with census data and looked at socio-economic characteristics, access to the sites, geographic location, and other characteristics to determine whether or not the control sites selected were good matches with our study sites. In some cases, new control sites were selected and data is now being collected for those sites. Later in the summer, I managed to obtain a list from the National Water Commission of localities in Guerrero that have registered water systems. We are in the process of re-evaluating our control sites again, to assure the water sources available match those of the intervention communities.

UV Waterworks, Las Trancas.

Additionally, I determined whether or not the data that had been collected could be used in the study. As a health clinic often serves more than one locality, the location of the health clinic had to be compared with the location and geographic dispersion of our study sites to determine whether or not the data collected adequately represented the actual incidence of disease for that site. Due to distance, time, hours of availability of services and transportation limitations, it is possible that patients do not attend the health clinic to which they are assigned. Furthermore, it is difficult to disaggregate from the data collected to which of the many localities covered a particular case belongs. Thus there may be cases reported at a given health clinic which belong to a location other than our study sites. Additionally, since some of the water systems we are studying only serve a maximum of 3000 inhabitants, we needed to make sure that the size of the population does not exceed that number.

UV Waterworks in health clinic in Tetipac.

I also contacted and solicited data from Oportunidades, a government program that provides health education and services in Guerrero. Data on which communities are participating in and what percentage of each of those communities is covered by the Oportunidades program as well as information on the activities Oportunidades is realizing in each community are essential to this study, as those factors will influence the incidence of disease in the community.

The next step, once the data that had been collected was inventoried and evaluated, was to visit the study sites to find out if it the data accurately represents in situ conditions. To do so, we visited 22 localities in 10 different municipalities. The sampling scheme used was a pseudo-cluster random sampling method. For each region, a municipality was randomly chosen and we tried to visit as many study villages within that municipality as time and transportation would permit.

Site Visits

The purpose of the 22 site visits was to familiarize ourselves with in situ conditions, to meet with key leaders and community members, to understand better the historical and socio-economic context of each locality, and to determine the openness of community members to focus groups and surveys. During the summer we only visited villages which contain UVW filters.

In each village, the first step was to locate the UVW filter and as well as the person(s) responsible for the maintenance and upkeep of the UVW system in that community. In 14 localities the UVW filter was located in a health clinic, whereas in the remaining 8 localities the UVW filter was located in the Comisaría. Usually if the filter was located at the health clinic, the doctors and nurses knew who in the community took care of the water filter. However, if the filter was located in the Comisaría, the person responsible for maintenance was either the Comisario or a member of the health committee. We then interviewed those individuals in order to determine the historical functionality of the filters, the maintenance history, the use patterns, the approximate costs, and the community organization regarding the system. Furthermore, we asked questions regarding illnesses, nutrition, and education levels in the community as well as how those have changed over time. We also asked what other sources of water are available to community members, what use patterns and practices exist, how much water is available, and what treatments are given to the water prior to consumption. In the rare instances in which the UVW filter was functioning and water was available, we took samples of the water and tested for the presence of coliform bacteria.

Summary of Sites Visited:

The UVW filter was not operational in 50% of the villages visited. This was either due to mechanical failures, water scarcity, dismantling of the system due to planned relocation, or community disinterest. The other interesting finding was that in many of these villages, other sources of purified water are available.

Carol with Health Promoter walking to Ciulutla.

Interviews with Government Officials

The Ministry of Health plays an active role in rural communities via the provision of health care and health education services as well as via the provision and vigilance of water purification. In order to gain an understanding of the context (historical, cultural, and socio-economic) in which the UV water systems have been put in place and are maintained, we interviewed government officials working in the central state health department office. Beyond using these interviews to understand context, I wanted to use these interviews to inform the design of my research project so as to actualize a project that will provide useful information to the Health Department.

We spent three days meeting with and interviewing various officials. First, we spoke with two representatives in the Area de Fomento de Agua y Saneamiento. They told us about the activities in which their department has been involved, namely, water quality improvement, water quality testing, and monitoring and inventorying of water systems. The UVW systems were originally under the jurisdiction of another department within the Ministry of Health; however, they have been maintained and supervised by the Area de Fomento de Agua y Saneamiento for the past year and a half. The representatives from the Area de Fomento de Agua y Saneamiento provided me with a copy of the maintenance reports from the past year which were sent to the Secretaria de Salud by engineer contracted to supervise all 60 UVW systems. Furthermore, I was given a copy of the original inauguration papers which listed the names of the villages, the population, and a description of any problems that were present at the time of installation. I also received information about which municipalities seem to have the most difficulty ensuring an adequate level of chlorination in its water systems and the plans the Area de Fomento de Agua y Saneamiento has for future improvements to infrastructure, monitoring and water quality assurance.

Additionally, we were able to talk with Dr. Memeje, from the Programa de Accion Salud de Infancia. Dr. Memeje is responsible for the training of doctors and for child healthcare services. He explained to us the training process for doctors who are performing their year of social service, the process of record keeping, (key to understanding the GI data already collected) and the standard healthcare treatments and programs available.

Health Promoter and Comisarios (current and previous) in front of UV waterworks in Ciulutla.

We also met with Licenciado Diego Diaz, Secretaria Personal de la Secretaria de Salud. He is one of the top officials in the Ministry of Health and a key person both in terms of access to information as well as approval for collaboration. I explained to him the purpose of our study, talked about collaboration for future work and discussed with him the needs of the Department of Health. He expressed an interest in the project and said he would like to collaborate with us in the future.

Thesis planning:

Many of the in-site conditions that I encountered were different than I expected: a much smaller portion of the UVW filters were technically functioning and actually used by community members. Additionally, the sites in which they were functioning were not those I would have originally expected based on socio-economic and geographic characteristics. Furthermore, more communities have access to piped chlorinated water or other sources of purified water, and lower incidences of diarrheal disease than I had presumed. Although this might thwart some of my original research plans, I feel that 1) these are positive findings in terms of quality of life for the inhabitants of the study sites and 2) these findings suggest other questions regarding the role of common property management, the impact of state led health initiatives and the choices and constraints families make with respect to the source, quantity, and quality of water used. Moreover, the original premise of my research, to understand what social, cultural and political factors make some of these systems more effective than others still holds, as the UVW filters were working in some communities and yet totally dismantled in others.

Conclusions

The summer visit provided an excellent introduction to the research site, allowed for the meeting of key contacts, re-evaluation of the proposed project to make it better suited to on the ground reality and a productive data collection. During the course of the next few months I hope to analyze in depth the data we collected, write a paper on my preliminary findings, and develop more clearly the methods (and questions) which I will be using for future research.