Enabling data for decision making on drinking water safety through fit-for-purpose laboratories

In low resource and remote areas where billions of people lack safe drinking water, managers and users have limited access to regular operational water quality testing that can inform drinking water safety improvements. Increasing availability of methods enable operational monitoring in challenging settings, but approaches need to be embedded in operational activities to sustain implementation and affect change. We demonstrate how fit-for-purpose laboratories (FFPLs) operated to support water service providers can deliver data for operational and strategic water management decision-making (particularly E. coli data). Using an iterative action-research learning approach and implementation science framework we chart the development of FFPLs in Bangladesh, Kenya and Nepal over 5+ years, their pathways to sustainability and impact on water safety, demonstrating a shift from water quality testing to water safety improvements and management as capacity and knowledge increases. This is reflected in increased trust and legitimacy, built through reporting, that has helped leverage external funding for sustainability. We distil key considerations to guide the establishment of FFPLs in varied settings.