Preventing lead (Pb) contamination in rural community water systems in LMICs through analytical screening, policy and standards enforcement, and supply chain interventions

Lead (Pb) is a neurotoxic metal that can leach into potable water from plumbing components. This study investigated Pb contamination in rural community water systems in Ghana to inform strategies for reducing its occurrence in low- and middle-income countries (LMICs). We screened 101 systems, including 83 borehole handpumps and 17 mechanized piped systems, installed across seven districts during 2019-22, using a handheld X-Ray Fluorescence (XRF) analyzer. Despite manufacturer assurances that components were lead-free, 57% of tanks in borehole handpumps and 100% of taps in mechanized systems exceeded the international "lead-free" standard of 0.25% Pb w/w. Other components like riser pipes, rods, cylinders, and foot valves generally met standards. There were no significant differences in Pb content (p>0.05) for systems across districts or installation years. Consequently, we engaged original equipment manufacturers (OEMs) to source truly lead-free alternatives. Stainless steel taps from one manufacturer replaced leaded brass taps, and a second manufacturer custom-fabricated stainless steel handpump tanks and spouts to replace lead-containing galvanized steel components. These were verified lead-free via XRF before installation. Despite initial claims from multiple OEMs that sourcing lead-free components would be prohibitively difficult or expensive, the switch was logistically feasible and increased overall installation costs by only 2% or less. Our findings highlight vulnerabilities in global plumbing supply chains and manufacturing practices that can introduce Pb and harm consumers, and illustrate the value of independently verifying OEM assurances and specifications for lead-free components. We offer guidance for implementers to mitigate water Pb contamination, with some measures also limiting iron corrosion-related system failures. This includes adherence to product quality standards, analytical screening considerations, supply chain interventions, water quality monitoring, and progressive remediation of existing systems. This case study suggests that eliminating Pb from rural water systems is feasible and cost-effective in Ghana and other LMIC settings. • 101 Ghanaian rural community groundwater systems analyzed using X-Ray Fluorescence • 57% handpump spouts and 100% taps exceeded global lead-free standard (0.25% w/w Pb) • Switch to lead-free stainless steel increased net system installation costs by ≤2% • Low- and Middle-Income Country supply chains are vulnerable to lead contamination • Eliminating lead from rural water systems is feasible and cost-effective in LMICs