Water Safety Plans (WSPs) are internationally recommended risk assessment and management strategies for water delivery. However, documented outcomes and impacts from implementing WSPs are lacking, particularly for community-managed supplies. In this research, previously implemented, community-managed WSPs were evaluated in four countries through a mixed-methods protocol assessing: WSP implementation quality, WSP management via key informant interviews (KII) and focus group discussions (FGD), household characteristics, and collection-point and stored household water quality in WSP and non-WSP communities. Overall, 256 Mils and FGDs, 816 household surveys, and 1,099 water quality samples were completed. The quality of WSP implementations scored 6-13 out of 18 possible points. KIIs and FGDs found WSP communities had improved capacity to manage water supplies and identify key risks to safe water delivery. Fewer non-WSP community households reported paying for water in DRC and Vanuatu (p < 0.001). WSP community water collection-points had more E. coli contamination than non-WSP community collection-points in DRC (p = 0.009), Fiji (p = 0.020), and Vanuatu (p = 0.004); household results varied, although exploratory analysis revealed that non-WSP communities were imperfectly matched to WSP communities. Overall, we found: 1) incomplete WSP implementations; 2) small improvements in water supply operations; and, 3) no documented microbiological water quality improvements from WSPs. These results highlight that WSPs implemented in rural, community-managed supplies are challenging and question their effectiveness; if implemented additional technical and financial resources are necessary to support community-managed WSPs. (C) 2019 Published by Elsevier Ltd.
