Table 4.

Additional information on conditions for each type of institutions.

Condition	Water Suppliers	Surveillance agencies	Both
Enforcement	•In Zambia and Kenya, suppliers regularly reported to regulators and were periodically subject to audits. Regulators rated suppliers on their overall performance, including testing. •Other countries had little to no enforcement for testing. Some suppliers did not send testing data to any external regulatory bodies.	•There was a lack of enforcement; though water testing data was often sent to relevant national ministries (e.g., Ministry of Health), institutions received minimal or no feedback.	•Except for the suppliers in Kenya and Zambia, there was a substantial lack of enforcement for water testing. Most institutions were not penalized or incentivized for testing.
Knowledge	•Generally, suppliers only had a few staff dedicated to water quality, which enabled them to specialize and build expertise in water testing. •Most staff had theoretical training in water testing via degrees, diplomas or certificates on water-related courses.	•Often multiple staff were involved in testing, who were also responsible for other activities. •Most staff did not have theoretical training in water testing via degrees, diplomas, or certificates; staff had difficulty building substantial theoretical knowledge in water testing through short training courses.	•Lack of experience or knowledge led to testing methods often being performed incorrectly. •Staff with knowledge and experience in water testing often led testing activities and informally mentored other staff.
Motivation & leadership	•Consistent monitoring resulted in job ownership for dedicated staff. •The procurement of high quality equipment motivated staff. •Effective leaders ensured that sufficient resources were available for testing.	•Most surveillance staff received incentive payments to cover transportation and lunch allowances during sample collection and testing. •Staff that did not receive incentive payments often prioritized other incentivized activities (e.g., polio campaigns) over water quality monitoring.	•Training opportunities and the involvement of external partners motivated staff. •Attentive supervision encouraged staff to work productively. •Effective leaders managed the procurement and distribution of consumables and supplies.
Staff Retention	•Because often only a few staff managed testing activities, testing programs were sometimes interrupted while staff left (temporarily or permanently).	•Internal staff transfers were a common challenge (e.g., district health staff moving to other districts). •Some trained all their staff on water testing to minimize disruptions from internal staff transfers. •Qualified staff was difficult to retain in rural areas.	•Staff turnover was a challenge if new staff did not have adequate knowledge and experience. •Changes in government structures, such as the decentralization of national to county governments in Kenya, resulted in staff transitions.
Transport	•Most suppliers had vehicles or motorbikes for sample collection, but these were not always available (e.g., used by another department or didn't have fuel).	•Most used motorbikes, public transport and/or walked for sampling. If vehicles/motorbikes were available, they were shared with other departments or activities. •Some had to cover vast geographical areas resulting in high transportation costs. •Sometimes motorbikes were broken down and in need of spare parts for repair.	•Poor road infrastructure, particularly in mountainous areas and during the rainy season, made it difficult to collect and transport samples.
Equipment	•Suppliers often had previous experience with testing and therefore were somewhat familiar with equipment providers.	•Some surveillance agencies had minimal testing experience and therefore lacked contact information for equipment providers.	•Some institutions had easy access to distributors. •Most equipment/supplies were imported, which increased equipment cost and delivery time. •Occasionally, distributors ran out of stock.
Procurement			•Multi-step procurement processes delayed testing, particularly in larger institutions, though the processes aimed to minimize corruption. •Multiple bids were often required, though sometimes there was only one equipment provider in the country. •Miscommunication resulted in some institutions receiving the incorrect equipment.
Infrastructure	•Many had established laboratories for testing, some of which were ISO certified. •Water suppliers used electricity for operating their treatment plants and distributing water supplies. Therefore, power outages interrupted water distribution, which prevented the collection of water samples from the distribution network.	•Most lacked established laboratories; testing was often conducted in an office, school, or hospital. •Simpler testing techniques (e.g., presence/absence) were more common and had less infrastructure requirements. •If laboratories existed, they were sometimes used for other medical tests.	•External donors sometimes funded laboratory infrastructure. •Power outages interfered with the refrigeration of media and incubation of samples.