While substantive research on access to water has been conducted, the definition of access to water varies between studies and has evolved within monitoring institutions (e.g. JMP). Typically, measures of access to water include locational access (distance), time (to fetch water, waiting times), financial access (cost of water), microbiological and chemical quality or whether a source is improved/unimproved, and reliability (particularly for surface water sources).
Most monitoring of these dimensions of access are conducted cross-sectionally. Such measurements are unable to reflect changes in the water sources used across seasons, the dynamic nature of water availability, maintenance and governance issues which affect accessibility of water, or the eco-social processes which may influence access and the relationship between access and health. Evidence has now been emerging that many ‘improved’ water sources are, in reality, often unavailable for a variety of issues. For example, among 100 households in Uganda, we found that 30% reported using a ‘permanent’ water source (e.g. borehole) but were unable to obtain water at least once in the past two weeks. Such inaccessibility can lead to changes in water source type with implications for health. In our recent study, 26% of households in Uganda and 9% in Tanzania switched from a water source with a lower risk of contamination to one with a higher risk, from the dry to the wet season.
Even though water has been recognized as both an essential element of human life and an important factor in livelihoods and development, surprisingly we still lack a realistic understanding of day-to-day access to water, as a dynamic process, and the health implications of changing access over time. This water data gap and subsequent water management and planning problems exists in the USA too, as recent issues such as the lead contamination disaster in Flint, MI and the toxic algal bloom in Lake Eerie and subsequent water shut-off to the entire population of Toledo, OH exemplify.