A new study by researchers at RCSI University of Medicine and Health Sciences has found that combining rainwater harvesting with advanced solar water disinfection technology is the most cost-effective way to provide safe water in rural healthcare facilities in Malawi.

The findings could help reduce maternal and neonatal infections while delivering economic benefits in resource-limited settings.

Through the SURG-Water project, researchers evaluated various water supply and treatment strategies for maternity units in the Thyolo District, where limited access to clean water poses a continued risk of infections. It compared rainwater harvesting and groundwater extraction systems with several disinfection methods, including chlorination, ultraviolet (UV) technologies, filtration and an advanced solar disinfection (SODIS) reactor.

The study used a benefit-cost analysis to assess the installation, operation and maintenance costs of each technology over its lifetime and compare their long-term value for rural healthcare facilities.

The findings showed that the combination of rainwater harvesting and the advanced SODIS reactor produced safe water at the lowest cost and delivered the highest overall economic return. According to the analysis, every euro invested in the advanced SODIS system could generate more than €1,000 in health and economic benefits through reduced infections, improved maternal and newborn outcomes and lower healthcare costs.

“This analysis gives us confidence that the efforts of the SURG-Water project, which aims to harness sunlight and rainwater to bring safe water to mothers and newborns in Malawi, are heading in the right direction. We believe our idea to use sunlight and rainwater in rural health clinics can be scaled up now to make a real impact on the most vulnerable people in this country and beyond,” said Dr Jakub Gajewski, Programme Director at RCSI Institute of Global Surgery and co-lead of the SURG-Water project.

The findings address a significant challenge facing Malawi's healthcare system – almost 40% of primary healthcare facilities have an intermittent or unreliable water supply. This compromises hygiene practices during childbirth and places women and newborns at greater risk of infection. It also forces women and guardians to fetch water from outside the facilities, leading to poor care for newborn babies and their mothers.

The research estimates that inadequate access to safe water for medical hygiene in rural maternity wards creates an annual economic burden of over €45,000 due to preventable maternal and neonatal infections. Improving water access could reduce these infections by up to 30%.

Professor Kevin McGuigan, Director of the RCSI Solar Disinfection Research Group and co-lead of SURG-Water, said: “Unlike chlorination and other water treatment technologies that rely on continuous chemical supplies, electricity, or frequent maintenance, the advanced SODIS reactor requires minimal operational input once installed. Its simplicity, scalability and low long-term costs also make it particularly well suited for settings with limited resources including schools, markets, correctional facilities and other community spaces.”

SURG-Water is a Research Ireland-funded joint project between Malawi University of Business and Applied Sciences (MUBAS) and RCSI. It aims to improve access to safe water in rural health facilities in Malawi in support of UN SDGs 3 and 6, by developing rainwater harvesting systems combined with novel solar water disinfection technology that can realistically be manufactured and maintained in local communities.

The RCSI Institute of Global Surgery, based in the RCSI School of Population Health, is dedicated to improving access to safe, affordable surgical, anaesthetic, and obstetric care in low- and middle-income countries.