The Healthy Networks Water Treatment (HNWT) project aimed to implement a social network-based intervention to promote safe drinking water on Mfangano and evaluate intervention impact.


Water is abundant on Mfangano, however most drinking water comes from the contaminated surface water of Lake Victoria. Water treatment with chlorine-based methods can be expensive and is not always used routinely. The HNWT project was developed to evaluate a social network strategy for promoting uptake and sustained use of locally made ceramic filters.

Project Description

HNWT built on the existing Mfangano Health Net (MHN) Microclinic program by training Microclinics, or informal social network groups, on topics related to safe drinking water and social support around promoting group behavior change. The idea is simply that social networks, through strong peer-to-peer influence and constant informal interactions, constitute a powerful mechanism for promoting difficult to maintain health behaviors over a prolonged period of time. In 2013, over 500 Microclinic participants went through these training sessions and received ceramic filters for drinking water treatment in the home.

 Study Activities

  • Baseline survey and water quality testing to determine pre-program status of household drinking water quality and treatment
  • Extensive mobilization efforts to ensure that household members responsible for treating water in the home joined Microclinic groups for training on water treatment and ceramic filter use
  • Three Microclinic education and social support sessions providing training on:

1) Waterborne illnesses and drinking water quality,

2) Water treatment methods and introduction to ceramic filters, and

3) Microclinic support for promoting group water treatment behaviors.

  • Longitudinal follow up to assess filter use and water quality over six months following intervention.


  • Our evaluation included 75 participants in the Mfangano East community who were participating in a Microclinic social network group and 75 participants in the neighboring Mfangano North community where Microclinic groups had not yet been introduced.
  • After 6 months, 84% (61/73) in the microclinic group and 81% (59/73) in the comparison non-microclinic group who were reached for follow-up were still using their filters.
  • At six months, 44% (32/73) of those in the Microclinic group and 46% (32/70) of those in the non-Microclinic had fecal coliforms present in at least one drinking water container in the house.
  • Eleven participants (7.5%) reported problems with their ceramic filter, generally either filter breakage or slowing of filtration over time.

Next Steps

  • Partnership between community groups and the Safe Water and AIDS Project (SWAP) to ensure availability of locally made ceramic filters for purchase on Mfangano.
  • Continued education via community groups of the importance of treating all non-filtered drinking water and educating the community that filtration with cloth only does not remove dangerous bacteria and viruses from the water.


  • Kenya Medical Research Institute (KEMRI)
  • University of California, San Francisco (UCSF)
  • Doris Duke Charitable Foundation (DDCF)
  • Safe Water and AIDS Project (SWAP)
  • Microclinic International (MCI)
  • Family AIDS Care and Education Services (FACES)


Matt Hickey, Co-Director of Research: matt [dot] hickey [at] ucsf [dot] edu