Water Scarcity and Water Quality: Identifying Potential Unintended Harms and Mitigation Strategies in the Implementation of the Biosand Filter in Rural Tanzania.

Bottom-up public health interventions are needed which are built on an understanding of community perspectives. Project SHINE is a community-based participatory action research intervention focused on developing sustainable water, sanitation, and hygiene strategies with Maasai pastoralists in Tanzania. The aim of the study is to understand perceptions related to water quality and scarcity as well as to assess the potential of the Biosand Filter as a low-cost, low-tech water treatment option. To avoid unintended harms, the community was engaged in identifying potential harms and mitigation strategies prior to the implementation of the filter.Two in-depth interviews and two group discussions were analyzed using thematic content analysis, while three think tanks were analyzed using directed content analysis. The findings highlight a range of concerns regarding water scarcity and quality. The think tank approach was an effective means of engaging the community in identifying potential unintended harms across four dimensions: the physical, psychosocial, economic, and cultural contexts. In addition, two external themes emerged as salient: political harm and harm by omission.