Developing stakeholder participation to address lack of safe water as a community health concern in a rural province in South Africa

Jennifer Hove* (Corresponding Author), Lucia D'Ambruoso, Rhian Twine, Denny Mabetha, Maria Van Der Merwe, Ishmael Mtungwa, Sonto Khoza, Kathleen Kahn, Sophie Witter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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Despite legislative and policy commitments to participatory water governance in South Africa, and some remarkable achievements, there has been limited progress to improve the water infrastructure servicing in marginalized rural communities. Around five million South Africans still do not have access to safe water.

This paper seeks to understand and advance processes to engage multisectoral stakeholders to respond to lack of safe water as a community-nominated health priority in rural South Africa.

We engaged representatives from Mpumalanga Department of Health (MDoH), rural communities, other government departments and non-governmental organisations (NGOs) to cooperatively generate, interpret and act on evidence addressing community-nominated priorities. A series of participatory workshops were conducted where stakeholders worked together as co-researchers to develop shared accounts of the problem, and recommendations to address it. Consensus on the problem, mapping existing planning and policy landscapes, and initiating constructive dialogue was facilitated through group discussions in a collective learning process.

Community stakeholders nominated lack of safe water as a local priority public health issue and generated evidence on causes and contributors, and health and social impacts. Together with government and NGO stakeholders, this evidence was corroborated. Stakeholders developed a local action plan through consensus and feasibility appraisal. Actions committed to behavioural change and reorganization of existing services, were relevant to the needs of the local community and were developed with consideration of current policies and strategies. A positive, collective reflection was made on the process. The greatest gain reported was the development of dialogue in ‘safe spaces’ through which mutual understanding, insights into the functioning of other sectors and learning by doing were achieved.

Our process reflected willingness and commitment among stakeholders to work together collectively addressing local water challenges. Location in an established public health observatory helped to create neutral, mediated spaces for participation.
Original languageEnglish
Article number1973715
Number of pages14
JournalGlobal Health Action
Issue number1
Publication statusPublished - 20 Sept 2021

Bibliographical note

This 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.


  • Participatory water governance
  • multisectoral stakeholders
  • community evidence
  • local action plan
  • water challenges


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