Adaptive strategies to enhance water security and resilience in low- and middle-income countries: A critical review.

The water sector is facing unprecedented pressures as increased environmental and anthropogenic challenges, such as climate change and rapid urbanization, impact the availability and predictability of safe drinking water. There is a need for practitioners and policymakers to integrate water security and resilience (WS&R) factors into programming to sustain investments in drinking water systems to support associated economic, security, and public health benefits. In response to intensifying impacts from WS&R risks, communities around the world are developing adaptive strategies, and a critical review of these strategies may provide lessons that can be implemented at scale. In this critical review, we systematically screened over 9000 peer-reviewed and grey literature articles and extracted data from relevant studies that propose, pilot, and/or evaluate adaptations in low- and middle-income countries (LMICs) and evaluated the suitability of each adaptation for different contexts. We created a portfolio of adaptive strategies from over 75 LMICs to inform practitioners and policymakers in enhancing the resilience of drinking water systems. Over 20 adaptations were identified, including strategies such as stormwater management, wastewater reuse, non-revenue water reductions, water pricing, and public awareness campaigns. We categorized adaptations by function (improving water management, augmenting existing supplies, reducing water demand) and scale (household, municipal, regional) to provide recommendations tailored to local needs. For each adaptation, we highlighted associated strengths, weaknesses, barriers to adoption, and enabling environments for successful implementation. We propose a novel decision-support tool, called STEP WS&R, that provides a consistent and replicable process for informing high-level investment and policy choices around WS&R. This critical review presents recommendations for practitioners and policymakers to invest in WS&R adaptations, catered to shared risks and contexts.