Sector perspectives on the attributes of system approaches to water, sanitation, and hygiene service delivery

This study sought to coalesce sector knowledge on the use of systems approaches for sustainable water, sanitation, and hygiene (WASH) service delivery in low-income countries. To accomplish this objective, we remotely convened a panel of WASH sector experts within a multiround survey to identify, characterize, and prioritize the necessary attributes of WASH systems approaches. The first survey round asked experts to comment on the conceptual differences between traditional approaches and systems approaches to WASH. Emerging within responses from the first survey round were attributes of WASH systems (i.e., factors, actors) and attributes of WASH systems approaches (i.e., flexible, scalable). A three-round Delphi survey was then administered to reach consensus on these emerging attributes. By the final round of the Delphi, consensus was reached on every attribute of WASH systems, indicating alignment between the experts on the fundamental characteristics and implications of WASH systems. Consensus was also reached on the majority of attributes of WASH systems approaches, including the inherent interconnected and complex nature of WASH systems. However, consensus was not achieved on attributes related to mapping WASH system interconnections, convening stakeholders in collective action, and the appropriateness and feasibility of applying systems approaches at scale. This indicates a need for future research that explores practical and scalable tools and techniques to map and evaluate WASH system interactions, and ways to engage relevant actors in these approaches to collectively apply systems knowledge. [author abstract]