Water and Sanitation: Decisive Effects in Modern Operations


Defense organizations, particularly the Army, need to prepare for and train to implement water and sanitation projects in developing countries.  Many developing countries face a critical shortage of adequate water and sanitation facilities, which places an unnecessary burden on already over-stressed health care services and supporting government entities.  Establishing basic services and improving health worldwide are key components of stability operations and important constituents of the national security strategy.  To be successful, however, projects must be sustainable.  Progress in stabilizing the developing world is slow and requires continued efforts.  With careful consideration of social, political, technological, and environmental factors, government and non-governmental organizations can develop sustainable solutions that are acceptable and suitable to target communities.  The Army plays an important role in water and sanitation development because its units commonly deploy to austere environments with people in desperate need of basic services.  These people often live outside municipal areas receiving benefit from centralized services.  New and appropriate measures of effectiveness concerning water and sanitation projects are necessary to drive successful practices.  Additionally, home station training needs to prepare junior leaders for community partnership and understanding the planning and development of water and sanitation projects.  The purpose of this article is to explore why improving water and sanitation infrastructure is critical to the Army’s effort to bring stability in developing countries.  This article also provides better metrics specific to water and sanitation projects, and provides guidance for battalion and company leaders as they conduct pre-deployment training.  

Stability operations

In the 2010 National Security Strategy, President Obama identified progress in the developing world as a “strategic, economic, and moral imperative.”  That same document describes the threat that economic and social imbalances pose to global economic stability and our national security.  The prosperity gap between western and developing countries can serve as a catalyst for armed aggression against the United States.  Additionally, the United States promotes human dignity by protecting basic human rights across the globe.  Continued efforts to develop foreign infrastructure are, therefore, a key component of US national security and are consistent with strategic interests. 

In the future, the defense community is likely to spend the majority of its time and effort on stability operations in the developing world.  Commanders apply a unique mix of full spectrum operations, including combat, counterinsurgency, and stability operations, to almost every operational situation.  While stories of heavy fighting dominate the media, leaders on the ground recognize that the vast majority of current US efforts can be considered stability operations.  Following periods of armed conflict, government and non-governmental organizations (NGOs) can struggle to restore basic services, develop infrastructure, and provide for basic human needs.  Soldiers are often in the best position to affect positive change in the most desperate communities, but often lack the training to properly lead such efforts.  Persistent needs in Iraq and Afghanistan have required Army units to address these humanitarian concerns.  Most efforts to date have not, however, yielded positive and lasting results.  These failures beg the question: should the Army engage in infrastructure development to meet basic human needs?        

There is a strong correlation between instability and poverty across the globe.  The most unstable countries are developing nations with poor economies and failing or non-existent infrastructure, including basic water and sanitation services.  In accordance with the National Security Strategy, the US Army will continue to conduct operations in unstable developing countries where these basic services are not present. The US military has a strategic and moral obligation to help improve lives in the regions to which we deploy.  Development as a part of stability operations is crucial and often decisive in today’s operational environment.

 The importance of water and sanitation

In the developing world, deficiencies in water and sanitation infrastructure are some of the most pressing needs.  An alarming number of people have no access to clean drinking water and improved sanitation, which drastically increases the risk of water-related disease.  Water-related disease accounts for a large fraction of deaths in developing countries, particularly in children under five.  The United Nations estimates that worldwide 884 million people lack access to clean drinking water and 2.6 billion are without access to improved sanitation facilities.  These problems have led to growing global concern and efforts to reduce the number of people lacking basic services.  While global efforts to meet the drinking water goal are on track, the world is “dangerously behind in sanitation” (Figure 1).  Further, sustained efforts will be necessary to continually meet drinking water needs as populations continue to rise and global climate change alters traditional water supplies.  Inadequate or poor quality water is still a threat to poor residents in developing countries, and will continue to be so as the population increases.  Sanitation is a lesser acknowledged, but no less dangerous threat.  There is often a direct link between poor sanitation and poor water quality, and both pose a significant risk to public health. 

Figure 1:  According the latest UNICEF estimates, the world is off-track to meet sanitation goals.  Of the 2.6 billion without sanitation, 95 percent live in Asia and Sub-Saharan Africa - key areas of interest in US Security.

Unclean drinking water and improper treatment of waste are a leading cause of illness in the developing world.  In Afghanistan, water related diseases account for 29 percent of fatalities in children under the age of five.  The United States Agency for International Development (USAID) treats nearly one billion episodes of child diarrhea annually with lifesaving therapy.  For example, they report that 70 percent of visits to health clinics in Benin, Africa are due to diarrhea or other water-related disease.  Poor water quality is a clear cause, but it is not an isolated variable.  Water takes on the characteristics of its environment.  Waste deposited into fields or in open gutters percolates into the ground water or runs off into surface streams.  Human and animal feces are rich in pathogens and can quickly contaminate a water source.  Careful community planning and water resource protection is necessary to preserve drinking water sources and protect against preventable water-related diseases.    

Child mortality rates serve as an indicator of poor water and sanitation services.  Children under the age of five are more susceptible to waterborne disease than adults.  In areas with poor water and sanitation, young children die at an alarming rate.  For example, the World Health Organization reports an under-5 mortality rate of 199 per 1,000 live births in Afghanistan (down from 250 in 1990).  That is, a child born healthy has a 20 percent chance of dying before age five.  With 1.3M annual live births in Afghanistan, that means an average of 237,000 Afghan children will die every year.  More than 68,000 are expected to die of diarrhea and other water-related diseases annually.  For comparison, as of October 2011, 1,811 US servicemen and DoD civilians have been killed in Afghanistan to date; 14,611 have been wounded.  More than four times the number of Afghan children are likely to die from waterborne illness this year than all US servicemen who have been wounded and killed in Afghanistan and Iraq since the beginning of the conflicts. 

Social stability requires the basic provision of water and sanitation services.  With such a high mortality rate among young citizens, stability in Afghanistan or similar countries is naturally difficult.  The United States and its coalition partners have recognized this problem and have invested in development of municipal services in many built-up areas in Iraq and Afghanistan.  Organizations such as USAID and the Army Corps of Engineers are well suited to plan and implement such projects.  Provincial Reconstruction Teams (PRTs) also have the capacity to identify and plan water and sanitation projects and help to serve those most in need.  Only 20 percent of the Afghan population lives in cities.  Therefore, the development of municipal services only improves the lives of a minority of Afghans.  Worldwide, 70 percent of people without improved sanitation live in rural areas.  Decentralized efforts are needed to address the water and sanitation needs of rural communities.  Often, Army units in the field are best postured to take action and mitigate the dangers posed by the lack of proper water and sanitation.    

Why well-intended projects fail

Initiatives to bolster water and sanitation infrastructure must be sustainable within the unique political, social, technological, and environmental factors of the local area.  Taking time and effort to understand these factors will help mitigate risks to project effectiveness and sustainability.  Failure to do so can create unsustainable solutions that reflect poorly on the local government and coalition forces, and can cause social harm that works counter to stability operations.  Projects such as these can become monuments to failed government efforts and undermine the legitimacy coalition forces hope to promote.     

Current practices for infrastructure development are often wasteful and ineffective at addressing local needs.  The 2011 Commission on Wartime Contracting reports that between 31 and 60 billion dollars have been wasted on discontinued and unsustainable projects in Iraq and Afghanistan.  The commission suggests reform of contingency contracting and regular assessment to track progress and efficacy of development projects.  The need for this exists both at the regional and village scale.  Too many US-funded projects fail to meet the stakeholder needs due to poor consideration of operations and maintenance (O&M) requirements.  Local operators must commit and have appropriate training and materials available to operate and maintain a system over the long term.  Roads require maintenance crews and equipment.  Water treatment plants require energy and chemicals.  Schools require teacher training, curriculum development, and supplies.  Decision makers too often focus on the infrastructure form, without adequate consideration of the function these projects should perform.  This can lead to premature failure of the project.  Sustainable solutions must be designed within the ability of the local community to operate and maintain the system. 

When ownership exists and a community invests itself in a project, citizens will defend, maintain, and expand the project after donor organizations have left. Citizens will abandon what donor organizations leave behind if they perceive that the project fails to meet their needs or does not belong to them. The development community achieves positive results when it patiently engages national and local leaders in their own development rather than trying to impose development quickly and autocratically from the outside.”

  • FM 3-07


Numerous examples exist in Iraq and Afghanistan that highlight the risks of improperly planned projects.  In Nassiriya, Iraq a $277 million water treatment plant failed to consider the lack of available power.  As a result, the plant is often off-line and produces poor quality water.  The local population refuses to use the water, and resorts to manual water collection from rivers and streams.  Similar examples exist throughout Afghanistan.  Improperly nested projects at the village level also yield poor results.  In Kamdesh, Afghanistan, the author contracted several water distribution projects in six separate villages.  The rapid pace of the projects overwhelmed the local leaders and the fast infusion of cash disrupted local markets.  Furthermore, it was difficult to prevent corrupt financial practices and several local leaders misused project money.  Those who did not misuse funds were often the target of public scorn and found themselves incapable of making progress on the project.  The area was not ready for such fast-paced development.  They needed partnership and collaborative community planning.  Military leaders failed to understand social and political nuances and became a limiting factor in development.  For a project to be sustainable, military leaders need to develop close partnership with target communities and distribute cash only when the conditions have been appropriately set.   

The military can draw lessons from non-governmental organizations (NGOs), who have experienced similar challenges with sustainable water and sanitation infrastructure development.  Studies suggest that approximately 50,000 water points constructed with foreign assistance in rural Africa are broken, representing a wasted investment in excess of $360 million.  Some developing regions have experienced project failure rates up to 70 percent within three years.  These failures are attributable to a lack of community involvement in planning, construction, and commitment to maintain the system over the long term.  Challenges such as these confront every aid organization across the globe, and have forced activists to pursue more modest solutions developed by the community to serve themselves.  While potentially more difficult for the developer, water and sanitation infrastructure projects can be successfully integrated into local communities if they are simple and nested with the social fabric of the community.    


How to ensure sustainability: developing metrics at the brigade level

To promote sustainable practices, Army units must adopt new measures of success for development projects.  Asking the wrong questions can encourage subordinates to adapt a fast-action, rampant-spending mentality, which will fail in most developing nations.  Metrics that focus on the number of projects contracted, dollars spent, and number of people served fall into this category.  These metrics, while easily quantifiable, do not indicate whether water and sanitation projects meet the objective of long-term sustainability.  Brigade combat teams can refocus their programs by stressing better measures of effectiveness.  These may include the following:

  1. Number of cases of diarrhea treated at health clinics.  This metric is an indicator of health conditions in the area.  While only a fraction of diarrhea cases go to the health clinic, the trend can indicate whether the water or sanitation program has been effective at improving public health.  These statistics may best be reported through NGOs or other health service officials to minimize the presence of combat Soldiers in and around health clinics and alleviate reporting bias. 
  2. Infant mortality rate and under-five mortality rate (per 1000 live births).  As previously stated, children under the age of five are most susceptible to water-related diseases.  This death rate can be an important indicator of successful water and sanitation programs.  These numbers may be attained through NGOs but may be more difficult to access in very rural areas.  Community reporting through its leaders may be an effective means of collecting this data, once local leaders understand its importance. 
  3. Average quantity of water collected per person and average time it takes residents to collect water.  This metric is best collected through surveys from the general populace on routine patrols.  Such informal surveys give soldiers an opportunity to interact with the general populace in a non-threatening manner.  The results of the surveys can indicate the quality of drinking water sources and can be used to generate a list of water projects required in an area.  Additionally, an increased quantity of water collected over time can indicate that other water-related activities, such as bathing, washing, and hygiene, have also increased.  
  4. Hours spent working collaboratively in developing community water and sanitation programs.  Reported by junior leaders, the investment of time is an important indicator of a community’s commitment to their program and the degree of our partnership with the people.  Note:  There may be hundreds of hours committed to developing a village water and sanitation program before consideration of an engineered solution. 
  5. Number of local people (i.e., Afghans) receiving specific training and/or education.  Reported by junior leaders or directly by PRTs.  Programs that teach skills such as carpentry, masonry, and plumbing can give locals a means to support themselves for years after coalition forces leave.  Also, members attending formal hygiene and sanitation education can serve as an indicator of community awareness.  
  6. Percentage of community members with improved latrines.  The importance of proper sanitation facilities is crucial to improving quality of life and public health.  This data is best collected by junior leaders on routine patrols where they can inquire about the presence or absence of a family latrine.  Note: junior leaders should engage in such surveys only after they have gained the trust of the community and identified water and sanitation programs a priority with local leaders.  
  7. Number of hours the project is operational per day.  Once constructed, tracking the number of hours infrastructure is used by the local populous can be a strong indicator of effectiveness.  This metric could be tracked similarly to how Army units track pacing items.

How to ensure sustainability: implementation at the battalion and company level

Metrics do not solve problems; units on the ground must engage the population and work collaboratively to understand and develop water and sanitation systems.  Close partnership with local leaders is the most crucial element for sustainable projects.  This partnership is also vital to successful counterinsurgency practices.  Collaborative efforts to improve water and sanitation can provide unit leaders with a nucleus of partnership within local communities.  While they vary from location to location, working to define community needs and understand social, political, and environmental factors is imperative to creating sustainable solutions.  Junior leaders need to spend time teaching water and sanitation principles to the community.  They should also spend time learning about the local customs, leaders, and environmental conditions.  In many aspects, time spent partnering is more important than a monetary investment in the community. 

To ensure success during deployment, units should make efforts pre-deployment to identify and train personnel to understand water and sanitation issues.  Successful partnerships require leaders to have a fair understanding of common water and sanitation problems and practices used to address them.  To accomplish this objective prior to deployment, battalions should conduct training in infrastructure assessment and basic local construction.  Soldiers should also have a firm understanding of the linkage between poor sanitation and failing public health.   Battalion-level leaders should integrate education on safe drinking water, sanitation practices, and disease mitigation into their training.  Units can develop these principles into an integrated concurrent training program.  Company leaders need to also consider how they can establish education programs on safe drinking water, sanitation practices, and disease mitigation in country.

Sustainable practices require patient leaders who encourage creative thinking and emphasize partnership over rapid results.  In a one-year deployment, it is tempting to demand metrics and activities that produce results on a weekly or monthly basis.  However, sustainable capacity building requires an investment over longer periods of time that may not produce material progress within a year.  It is possible that a unit can spend a one year deployment successfully engaged in water and sanitation planning without building a single project.  They will have set the conditions for follow-on units to finance several projects that are well-nested in the receiving community and far more sustainable over the long term.  The practice of moving more slowly and building long-term capacity within the community is consistent with current counterinsurgency and stability doctrine and lessons learned by water and sanitation activists in Africa, South America, and Asia. 


Army units can, and should, work to develop water and sanitation infrastructure in the developing countries to which we deploy.  Current metrics of success have led to numerous unsuccessful water and sanitation projects and have wasted large amounts of money.  While organizations such as the USAID and the Corps of Engineers are capable of implementing effective projects, Regular Army units are often in the most intimate contact with the local populous and, therefore, are in the best position to assess and develop successful water and sanitation projects.  New metrics of success will reduce waste and create a better atmosphere for the development of successful projects at the battalion and company-levels.  Properly trained company leaders need to work intimately with local leaders to develop sustainable water and sanitation that will be successful long after coalition forces have left the region. 

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I agree with the author’s conclusion. The authors were correct to say that a correlation exist between adequate potable water, sanitation facilities and the health care services. I would like to take the article to the next level of order of effects. Not only must we focus on the clean water and sanitation, but also the second order effects that bad sanitation creates. With the changing environment around the world, the possibility of a broader scope of diseases arises. The lack of clean water and sanitation breeds mosquitoes, flies, and rodents which are vectors of some of the worst diseases and sickness known in all countries. As the authors states that children under the age of five are more susceptible to waterborne disease than adults, but add the second order effects of vector borne diseases and the situation has now become an area that can effect anybody in a larger area. By promoting the implementation of providing the clean water and sanitation to various countries, we are not only promoting human dignity for the local population, but also protecting the U.S. Military and non-military forces around the world. Mosquitoes, flies, and rodent carry a variety of diseases that include malaria, Hantaviruses, Dengue fever, encephalitis, and other illnesses that many people do not realize that the lack of sanitation and clean water create.
I recently worked on a dengue outbreak for the most densely populated place on earth. The dengue fever outbreak was due to water and sanitation issues. This issue was due to water storage issues and a large waste dump on one side of the island. This island is located in the Marshall Islands and has over 14,000 people located on thirty one hectares of land. This area could be considered a desert because it is surrounded by salt water and the only potable water comes from lens wells and a desalinization plants. The desalinization plant rarely works, and the local population believes the lens wells are contaminated. Most water comes from a local Army installation twenty minutes away by boat. The majority of the residence collects rain water in several large uncovered collection containers. This situation creates an excellent breading area for mosquitoes (Aedes spp.), Aedes spp is the vector for dengue fever.
I agree with what the first commentary that said, “You need to get buy in from the local civic leadership” in order to accomplish anything that will last for a long time. Whether the situation is trying to improve the water and sanitation system or a mosquito problem, buy-in from the people is the most crucial issue. If the local population takes personal ownership of the projects they will be proactive toward the mission’s completion and continued maintenance. As is the case no matter where we are in the world and trying to assist the local population, we will always hear, “We need to win the hearts and minds of the people”. I know we have heard this a lot, but it is true, because whatever project the local population leadership really wants the project is ensured to be a success if the people’s minds, hearts, and hands are really in it. On this small island, we were able to get buy in, by meeting with their king’s son and other people throughout the neighbor hoods. After we taught them to cover the water containers and why they were doing it, we putting up pictures of the king’s son covering his containers. I believe that by demonstrating the effects of not covering up their water containers and convincing them that many of the people were sick from the mosquitoes that were breeding in the water, we start to get a little understanding from the people. I was only on the island for a short time and was not able to do personal follow-ups. I was informed that about 60% began using netting to cover their containers; therefore, I believe that the “buy in” that we achieved was a result that this was the third visit to the island over the past year. We also cooperated with the Marshall Island Environmental Protection Agency and the local Ministry of Health which consisted of and many of the doctors and local health care workers. We were also able to talk and work with the king's son. He showed the population how and why they are covering their water containers.
I agree with Kevin James, the first commentary when he said, it is going to take time to build a foundation within the local community to get buy-in that will last and become a part of their culture. If we are able to do this, we can affect communities to effectively maintain their own water supply/system and sanitation system.

I wholeheartedly agree with the authors’ points as well, and believe that the most important point toward implementation of fixing the overarching problem with project completion rates is captured in the last section of their writing; particularly the third from the last paragraph.

Without first ensuring buy-in from the local civic leadership, your projects are probably doomed to failure. Even if you successfully install equipment to improve the overall quality of life for the local population, if local key leaders don’t get a benefit from it, it is likely that they will not be too concerned about sustaining it afterwards. This sounds somewhat cynical, but anecdotal evidence abounds, and given the current location of most contracting efforts (i.e. the Middle East), it almost seems as though utilizing local officials to identify which projects are needed should have been common sense back in ’04-’05, even though it wasn’t. Well meaning U.S. units frequently started projects that they felt were necessary, only to have them fail because they proved unimportant, unsustainable, or unwanted.

The slow pace associated with the completion of many projects, especially those of a larger scale, requires civic leader buy-in because they need to be able to demonstrate to the local populace that, as my brigade commander used to say, the “juice is worth the squeeze”. An Information Operation style effort of highlighting project openings, closings, and major milestones is an excellent way to increase the legitimacy of the local leadership as well as to serve as a reminder to the populace that improvements are coming, some just take longer than others. This gives the project ownership to the local populace and leadership, and will help facilitate sustainment after U.S. Forces depart. It should be done regardless of the size of the project; from the smallest street light project initiation to the largest water purification plant completion.

I believe another metric that could and should be added is some way to codify the amount of local leader buy-in and participation in the planning and execution of the project timeline. This isn’t overly difficult to measure, as it could be done through tracking meetings with the leader in question and their ability to meet certain gates or complete certain deliverables to a certain time and quality standard. Then, not only will projects “promote human dignity” as the author suggests is our strategic and moral imperative (and frankly our obligation to the American taxpayer too), but it will lead to further “cultural dignity” as well. The usefulness is that these metrics can then be used in furtherance of other Lines of Operation or Effort as well, as they can be used to measure Governance capabilities.

I agree that a challenge could theoretically exist if there is no such thing as “local civic leadership”. This forces us to spend a little more time becoming familiar with local personalities, and frankly speaks to the importance of cultural understanding of the areas in which we operate. Even if there is no such thing as a locally elected leader, there may be a tribal or religious leader who is the right one to interact with. Whoever it is, it is important that we carefully ensure we are lending the legitimacy that comes with such a thing as opening/closing/overseeing a project to the right person. This sort of knowledge is likely not resident at the brigade level, and will require either RFIs to higher (someone in the G7 shop can point you in the right direction) in an effort to gain further cultural insight, or thorough personal study, which can be onerous at best.

Finally, I believe that some issues can be mitigated in a couple of additional arenas as well. Additional training at the brigade level on how to properly execute contracts will greatly assist not only in the establishment of realistic contracts, but in the effort to bring the contracts to a successful close as well.

I agree enthusiastically with the authors’ conclusions. I also want to emphasize their second-to-last paragraph because I think it really gets at why the Army has been party to an unfortunately large number of failed water and sanitation projects. Failure rarely flows only from projects being ill-conceived or gauged according to inappropriate metrics—even though there are plenty of examples of both. Most military units simply do not have the patience to do small-scale infrastructure projects properly. They are too rushed, usually resulting from the limits of their deployments. Nine months or even a year are almost never enough time to conceive, implement, and then monitor a project.

Explaining why Army units rarely take a project from conception to successful implementation is not difficult. Learning curves and human nature are sufficient when put into the context of unit rotations. A unit newly arrived in theater wants to make its own mark, and often pays little more than lip service when promising to follow through on the infrastructure promises made by previous units. This is the ‘build a better doghouse’ mentality in action. The thinking goes like this: why complete the project initiated by my predecessor when I can start work on a new and better idea? Too often that unit cycles back to home station before the project is complete and the cycle begins again.

Given enough time, a long-term implementation strategy, and leadership willing execute those plans that perhaps they didn’t write and/or won’t be able to supervise until completion, Army units can become more effective at enhancing small-scale infrastructure in theater.

Great analysis, especially of the wasted projects that suffer hasty implementation. I can count several missions spent "finding" water projects we paid for in SW Baghdad that were in disrepair, misused, or useless.

I get the impression that what this article is suggesting is deep level of involvement that borders on government administration. The recommended metrics, for example, would involve census-like commitment. While appropriate in an occupation role where the US is the clear form of official government, it does seem as a tall order for most of what the US considers "ideal COIN". An anecdote might help with the point.

In Yusufia nahia (district SW of Baghdad on the Euphrates) our squadron frequently promoted water projects through our Civil Affairs element. This was following established precedent as each of the several rotations before us had done the same. The result was numerous water purification, drip irrigation, and other such projects spread throughout 400+sq km. The area itself is farm land that is a canal nightmare with hundreds if not thousands of branches leading from the Euphrates into our OE. There were also clearly well-watered and poorly watered areas that seemed to follow a pattern.

The distribution of US "water works" did NOT follow a clear pattern, appearing arbitrary, and done mostly as a negotiating tactic for local support. Yet the original water distribution infrastructure was not damaged in any significant way. After some investigation the point of failure became clear. Under Saddam the local system of canals and gates was operated on a distribution schedule. The schedule was administered by a single office, serving an area of several hundred sq km, that could fine and penalize those that attempted to siphon or divert water flow. After we collapsed the civil services of Iraq, this schedule broke down and a new water distribution scheme was negotiated between several influential "sheikhs." A scheme that changed with local political fortunes, leaving those low on the power totempole high and dry.

The US solutions broke down for many of the reasons mentioned in the article: poor maintenance, no sense of ownership, as well as poor planning and diversity of systems. The local ground water was unusable for irrigation, which meant drip irrigation was ineffective. Drinking water purification systems became local power demonstrations (whose land one was next to mattered) and eventually would break down.

In reality, the solution was simple: restore and admnister the pre-war distribution schedule. Which required some sort of census of the population/farmland, followed by appointed officials to manage the water system who would then be empowered to threaten some sort of sanction. Of course, that meant the US Army would be the enforcer of sanctions, at least in the beginning.

Now I happen to be trained as a cultural anthropologist and am a card carrying member of the American Anthropological Association. Figuring out how the locals did it was something I enjoyed doing as much as the raiding and fire missions. Expecting the same type of engagement from a company level officer as a rule in our current force might be a stretch. But it has to be done in order to play administrator and not just bad-guy-hunter. Changing metrics is sufficient only if they are changed based on local conditions, which requires a pretty intimate understanding of the local infrastructure and problems. Metrics are then the result, not the beginning of an effective local water management scheme.