# Evaluation of the Portable Alternative Sanitation System (PASS) on In-Home Water Use and Quality of Life

> **NIH NIH S06** · ALASKA NATIVE TRIBAL HEALTH CONSORTIUM · 2023 · $352,026

## Abstract

PROJECT SUMMARY (ABSTRACT)
Water-washed diseases (infections related to inadequate water access and poor sanitation) are a preventable
public health issue that continues to affect the 1.4 million people in the U.S. who still lack access to basic water
and sanitation. The COVID-19 pandemic brought to the forefront a reminder that Native American households
are 19 times more likely to lack indoor plumbing than White households. Historically, AN communities with a
lower proportion of in-home piped water and sanitation services have disproportionately higher rates of
respiratory and skin infections compared to plumbed communities, and these infection rates decreased after the
installation of in-home water services in some communities. Inadequate funding, engineering challenges,
affordability, and now climate change have hindered the installation and maintenance of centralized piped water
and sewer systems in remote Alaska. There is therefore an urgent need to evaluate whether novel, targeted
water, sanitation, and hygiene (WASH) interventions reduce water-wash disease disparities. To address this
need, this study will evaluate the impact of a targeted WASH intervention developed specifically for American
Indian/Alaska Native (AI/AN) communities, known as the Portable Alternative Sanitation System (PASS), on
water use, waste management, water-wash disease and well-being (defined by both biomedical and locally-
defined categories) over time in AN households. We will do this through two Specific Aims: 1) Characterize the
lived experiences of household water- and sanitation security (HWSS), health, and well-being in remote AN
households across the water and sanitation service spectrum using community-based measures and 2) Evaluate
the impact of the PASS on in-home water storage and use, quality of life, water security and reliability, and
prevalence of water-washed diseases. Through this mixed methods, longitudinal study, we will provide evidence
that demonstrates how a targeted WASH intervention affects water-wash diseases, in-home water use and
waste management, and overall well-being in AIAN communities. This will also enable tribes, tribal health
organizations, and related stakeholders beyond Alaska to evaluate the PASS system to decide if it is appropriate
for their own communities. This study builds on our previous work in the community of Kivalina with a greater
sample size, comparison of data from piped and unpiped households, and longitudinal data from the post-COVID
era. To our knowledge, this is the first longitudinal evaluation of how an in-home point-of-use water treatment
and waterless toilet system affects household water and sanitation security, health, and well-being in an Arctic,
Indigenous context.

## Key facts

- **NIH application ID:** 10696006
- **Project number:** 5S06GM146094-02
- **Recipient organization:** ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
- **Principal Investigator:** Laura P Eichelberger
- **Activity code:** S06 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $352,026
- **Award type:** 5
- **Project period:** 2022-09-05 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10696006

## Citation

> US National Institutes of Health, RePORTER application 10696006, Evaluation of the Portable Alternative Sanitation System (PASS) on In-Home Water Use and Quality of Life (5S06GM146094-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10696006. Licensed CC0.

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