Pathways to the successful function and use of mid-tech household water and sanitation systems

Mid-tech water and sanitation infrastructure - interventions that make moderate use of resources, materials, and technology while providing improvements in health and well-being - may serve an important intermediate role for communities that cannot immediately get high-tech piped infrastructure. However, such systems must be socially appropriate, technically functional, and sustainable. We determined the combinations of technical and social conditions that contribute to the success of household, mid-tech water, sanitation, and hygiene (WASH) systems using qualitative comparative analysis (QCA). We collected data on 32 household mid-tech Portable Alternative Sanitation Systems (PASS) installed in remote, rural Alaskan communities for 1 year. We then coded qualitative and quantitative data for each household 'case' into fuzzy-set values for four technical conditions and four social conditions. We conducted fuzzy-set QCA analyses to determine combinations of conditions (pathways) that led to the successful function and use of PASS. We identified multiple pathways for the success of PASS units, requiring combinations of technical and social conditions. Our analysis reveals that the successful implementation of household mid-tech WASH infrastructure is complicated. We recommend that deliberate steps be taken to engage homeowners, provide appropriate training and support, determine ownership parameters, and ensure the technical sufficiency of mid-tech systems before they are deployed.