In the 1950s, shortly after the founding of the People’s Republic of China (PRC), the central government created the Patriotic Health Campaign (PHC) in order to standardize and disseminate health-focused educational materials intended to control and prevent infectious diseases (1). “Water improvement”, meaning measures aimed at providing safe drinking water for households in China, was an important part of the PHC. After 60 years of water improvement policies, programs, and investments, the rural water supply sanitation and hygiene in China has improved dramatically, and water-related diseases no longer negatively impact the rural population as they once did. In addition to improvements related to the quantity and quality of the rural water supply, water improvement programs also promoted improved hygiene, sanitation, and other health-related behaviors among rural households. Together, such initiatives have improved the quality of life and the health of hundreds of millions of rural residents, while also contributing to economic and social advancement across rural China (2). The purpose of this article is to describe how the PHC served as a foundation for the expansion and improvement of drinking water supply in rural China, and to summarize the key programs, projects, and initiatives that followed over the last 60 years.
Since the founding of the PRC, China’s government recognized the importance of rural water supply and sanitation and sought to promote the development of improved water and sanitation infrastructure and management (5). Water improvement actions were specifically embedded in China’s National Social and Economic Five-Year Development Plans as early as 1986.
In broad terms, China’s rural water supply development evolved over the course of four stages as summarized in Table 1. As a consequence of these decades of deliberate and planned efforts — especially the implementation of the Rural Water Supply Five Year Plans starting in 2005 — more than 520 million rural residents, including more than 47 million rural schoolteachers and students, now have access to some form of piped water supply. By 2019, the proportion of the rural population covered by centralized drinking water treatment and distribution had reached 82% (6).
Stage Period Primary water improvement programs Additional Details Initial development and improvement of decentralized water supply 1949 to early 1980s Basic water improvement measures (e.g., building well protection platforms and/or covers, separating drinking water sources used for people and livestock) Most measures were improvements to existing water supply systems; reservoirs, irrigation infrastructure, and some new drinking water facilities were also constructed during this period. Construction of centralized water supply infrastructure Early 1980s to early 2000s. ● International Drinking Water Supply and Sanitation Decade (7)
● The Rural People/Livestock Drinking Water Program
● China Rural Water and Sanitation Program (supported by the World Bank and Asian Development Bank).
The central government creates long-term strategies and plans for rural water supply, including the establishment of national water standards, and collaborates with international agencies. Rapid development of drinking water supply in rural areas 2000 to 2015 ● Rural Drinking Water Emergency Project Plan
●Rural Drinking Water 11th Five-Year Plan
● Rural Drinking Water 12th Five-Year Plan
Government agencies at all levels emphasize the importance of rural water supply, which is also incorporated into the National Socioeconomic Development Plan. These efforts are accompanied by a focus on sustainable development goals. The consolidation, improvement, and promotion of rural water supply 2015 to present ● Rural Drinking Water Supply Consolidation and Improvement Plan Focus on upgrading existing rural water supply projects and improving management and operation systems to further expand piped water supply in rural areas, with an emphasis on consistent compliance with national water supply and quality standards.
Table 1. The four primary stages of rural water supply, time period, and primary water improvement programs in China, 1949–2020.
Furthermore, the National Rural Drinking Water Quality Monitoring Network (NRDWMN) was created in the 1990s and included Rural Drinking Water Projects from Five-Year Plans through 2003 (8). From 2004 to 2007, the NRDWMN was incorporated into the National Health Risk Factor Monitoring System, an internet-based information system which covers all provincial-level administrative divisions (PLADs), cities, and counties. By the end of 2019, data collected for the NRDWMN covered >98% of the townships in China. As one of China’s largest public health monitoring systems, NRDWMN provides information related to water and sanitation management and serves to help safeguard drinking water safety around the country.
To improve the management and quality of rural drinking water supply, China has expanded from a focus on water quality testing to a more holistic water quality management model based on strengthening preventive measures across the water supply process. In recent years, several PLADs have started to use Water Safety Plans (WSP), a drinking water quality management approach and toolset promoted by the World Health Organization’s (WHO) Guidelines for Drinking Water Quality (9). The WSP is a comprehensive drinking water management framework which encompasses all steps of water supply from source to consumer. Although the implementation of WSPs in China is not yet widespread, the Ministry of Health (now called the National Health Commission, NHC) proposed Technical Rules for Sanitary Evaluation (TRSE) (for rural drinking water safety) in 2008 which were in developed in part based on WSP principles (10). Much like the WSPs rationale, the TRSE was designed to support the systematic identification of potential water quality risks in water systems and to help establish control measures to responsibly manage such risks (11).
Water Quality Improvement
Establishment and Improvement of the National Rural Drinking Water Quality Monitoring Network
From Water Quality Monitoring to Water Quality Management