By Hillary Birch, Theresa Hambokoma, and Trust Malawo

Last year, I (Hillary Birch) completed my PhD fieldwork in Lusaka, Zambia, a city facing multiple challenges in access to safe drinking water, as rapid urbanization and climate change mean residents face serious health consequences associated with poor sanitary conditions. In fact, my time in Lusaka took place in the immediate aftermath of one of Lusaka’s worst cholera outbreaks and during the worst drought in Southern Africa in 100 years.

My PhD dissertation explores how the practice of global health meets with the production of urban space, mediated through knowledge and infrastructures that produce water quality in cities. Grounded in theories of urban political ecology, critical global health studies, and science and technology studies, my research conceptualizes the quality of water as a contested attribute that draws a range of actors into water’s flows in urban space, either in one’s daily life or through projects and programs that change flows of water and waste. To uncover these connections in Lusaka, I traced efforts to measure and intervene in water quality management in the city over six-months of fieldwork, conducting interviews and focus groups with actors across the urban water cycle. My fieldwork was supported by an IDRC International Doctoral Research Award, and I was able to work with two exceptional research assistants, Theresa Hambokoma and Trust Malawo.

Together we conducted focus group discussions in two informal communities: Kamulanga and Chaisa.  Chaisa is one of the oldest informal settlements in the city. This densely populated settlement is located close to the central business district and the community’s population is composed of small-scale traders and casual labourers. Water infrastructure is managed by a community-run entity, the Chaisa Water Trust (CWT), where water is pumped from nearby boreholes and delivered to public water kiosks and a few individual household connections. Due to challenges in accessing water, including from high water tariffs and unreliable supply, residents often resort to using unsafe alternative water sources to meet their daily needs, including shallow wells and a nearby drainage canal.

By contrast, Kamulanga is a newly urbanized area in the periphery of the city that includes a mix of low-density affluent housing as well as poorer, high-density settlements. The Lusaka Water and Sanitation Company (LWSC) is responsible for all water services in Kamulanga, where groundwater is delivered to a very limited number of public water kiosks and an increasing number of household-piped connections. While there are similar challenges to Chaisa in terms of accessing treated water, in Kamulanga there are no easily accessible surface water bodies, so those who can afford it drill their own boreholes to access water while others are left to negotiate access to water from neighbours who have their own supply.

Based on our research in Chaisa and Kamulanga, we developed two policy documents that Theresa and Trust recently shared with key stakeholders during outreach meetings they conducted, including with the Chaisa Water Trust, the Lusaka City Council, and members of Kamulanga’s Ward Development Committee.

While key differences between these two communities emerged, such as the role of private borehole owners in delivering water in Kamulanga and the challenge of water distribution within a small-scale water network in Chaisa, there are important throughlines that suggest how different actors in Lusaka can reduce proximal causes of disease and support efforts to deliver good quality water at an urban scale.

Here are three such insights from our policy briefs:

‘Formal’ and ‘informal’ water sources are connected: While participants in both communities had access to a formal water service provider that sold treated water, persistent challenges in accessing these services encourage the use of ‘alternative’ water sources that are at high risk of contamination, including streams, open drainages, and untreated boreholes. There is a need to consider the multiple types of water available in any given community before designing a water supply intervention and to think critically about how the extension of a piped water network that does not offer safe, accessible, and consistent supply for everyone promotes the use of unsafe alternatives and deepens inequalities in water access.  

• “If the kiosk operator is not home, we can’t get water. We have to wait or go to the [drain].” – Participant 5, Chaisa

Perceptions of quality matter: Participants in both Chaisa and Kamulanga frequently raised concerns about visible contamination of the water they receive from public water kiosks and piped connections. Not only this, but participants were worried about the occasional ‘over-chlorination’ of their water that some believe causes gastrointestinal problems. In both cases, the poor taste, smell, and appearance of water proved important when choosing what water source they would access, with some preferring untreated water from boreholes or shallow wells because of the water’s taste and appearance. Here then the perception of quality is not simply a matter of opinion but has real consequences in the context of urban settlements where multiple water sources remain available to many.

• “The water from [LWSC] that we fetch sometimes is dirty because of the broken pipes” – Participant 4, Kamulanga

Protecting groundwater quality is a safe sanitation intervention: Even if water in these two communities was accessed at different scales and through different infrastructures, all participants relied on groundwater as their primary water source. In both Chaisa and Kamulanga, participants understood cross-contamination between sanitation infrastructure and their drinking water might occur due to the proximity between unlined pit latrines, damaged water pipes, and poorly constructed boreholes. As the observations of participants suggest, even if sanitation and water are often treated as separate interventions in global health practice, renewed attention to groundwater quality can offer a way to bring these two domains together.

• “We do not empty the toilets; we just bury them and dig out new ones” – Participant 12, Kamulanga

Our policy briefs proposed recommendations for how these findings can be integrated into future projects and programs in Lusaka and we will continue to develop other publications and articles to share our results. This includes in my own dissertation that examines how global health practice intersects with contemporary processes of urbanization, being generative of new ways of governing cities as water supplies become less stable due to climate change.

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Hillary Birch is a PhD Candidate in Environmental Studies at the Faculty of Environmental and Urban Change at York University. Hillary is a Dahdaleh Global Health Graduate Scholar in Planetary Health, and her research is supported by a SSHRC Doctoral Fellowship and a Susan Mann Dissertation Award.

Theresa Hambokoma (MSc) is a global health professional with qualitative research expertise in WASH and sexual and reproductive health. She is based in Lusaka, Zambia.

Trust Malawo is a public health professional and psychosocial counsellor. He is based in Lusaka, Zambia.

This research received funding from an International Doctoral Research Award through the International Development Research Centre (IDRC) in Ottawa, Canada. Thank you to the Southern African Institute for Policy and Research (SAIPAR) and ZAMBART for their support of this project in Lusaka. Ethics approvals were received from the ERES Converge IRB in Zambia (No. 2024-Mar-016) and from the York University Research Ethics Board. Additional authorization to conduct research was granted by Zambia’s National Health Research Authority (NHRA1119/12/04/2024).